Article (Scientific journals)
Laparoscopic Isthmocele Repair: Efficacy and Benefits before and after Subsequent Cesarean Section.
Karampelas, Stavros; Salem Wehbe, Georges; de Landsheere, Laurent et al.
2021In Journal of Clinical Medicine, 10 (24)
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Keywords :
cesarean scar; laparoscopic isthmocele repair; niche; subsequent cesarean section; uterine scar defect
Abstract :
[en] OBJECTIVE: To evaluate the effect of laparoscopic isthmocele repair on isthmocele-related symptoms and/or fertility-related problems. The residual myometrial thickness before and after subsequent cesarean section was also evaluated. DESIGN: Retrospective, case series. SETTING: Public university hospital. POPULATION: Women with isthmocele (residual myometrium < 5 mm) complaining of abnormal uterine bleeding, chronic pelvic pain or secondary infertility not otherwise specified. METHODS: Women's complaints and the residual myometrium were assessed pre-operatively and at three to six months post-operatively. In patients who conceived after surgery, the latter was measured at least six months after delivery by cesarean section. MAIN OUTCOME MEASURES: Resolution of the main symptom three to six months after surgery and persistence of laparoscopic repair benefits after subsequent cesarean section were considered as primary outcome measures. RESULTS: Overall, 31 women underwent laparoscopic isthmocele repair. The success rates of the surgery as improvement of abnormal uterine bleeding, chronic pelvic pain and secondary infertility were 71.4% (10 of 14), 83.3% (10 of 12) and 83.3% (10 of 12), respectively. Mean residual myometrial thickness increased significantly from 1.77 mm pre-operatively to 6.67 mm, three to six months post-operatively. Mean myometrial thickness in patients who underwent subsequent cesarean section (N = 7) was 4.49 mm. In this sub-group, there was no significant difference between the mean myometrial thickness measured after the laparoscopic isthmocele repair and that measured after the subsequent cesarean section. None of these patients reported recurrence of their symptoms after delivery. CONCLUSION: Our findings suggest that the laparoscopic isthmocele excision and repair is an appropriate approach for the treatment of isthmocele-related symptoms when done by skilled laparoscopic surgeons. The benefit of this new surgical approach seems to persist even after a subsequent cesarean section. Further investigations and prospective studies are required to confirm this finding.
Disciplines :
Reproductive medicine (gynecology, andrology, obstetrics)
Author, co-author :
Karampelas, Stavros
Salem Wehbe, Georges
de Landsheere, Laurent  
Badr, Dominique A.
Tebache, Linda 
Nisolle, Michelle ;  Université de Liège - ULiège > Département des sciences cliniques > Gynécologie - Obstétrique
Language :
Title :
Laparoscopic Isthmocele Repair: Efficacy and Benefits before and after Subsequent Cesarean Section.
Publication date :
Journal title :
Journal of Clinical Medicine
Publisher :
MDPI, Basel, Switzerland
Volume :
Issue :
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 01 February 2022


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