Clinical success rate of extensive hysteroscopic cesarean scar defect (CSD) excision and correlation to histological findings
2019
Abstract Study Objective CSD (cesarean scar defect) is often associated with post menstrual bleeding, infertility and pain. Hysteroscopic CSD repair was described in the past, mainly as
excisionof the proximal edge of the defect to allow continuous blood flow during menstruation. In this study we aimed to evaluate the efficacy of extensive hysteroscopic cesarean scar
niche
excisionin symptomatic patients. Design Patients were followed for a minimum of 1 year following hysteroscopic CSD
excision. Clinical information obtained included detailed obstetric history, preoperative and postoperative menstruation pattern. Patients Symptomatic patients who were treated with hysteroscopic CSD
excision. Patients were considered eligible for the procedure in case myometrial thickness of 2mm or more was observed on sonohysterography (SHG) Setting Tertiary referral center Interventions Extensive CSD
excisionwas performed using a cutting loop and pure cutting current. The proximal and distal edges of the defect were resected. This was followed by resection of tissue at the base of the
niche, until underling muscular tissue was evident. Tissue sampled from the base of the cesarean scar defect was collected for histologic examination. Measurements and main results Between 2011 and 2016, a total of 95 patients underwent extensive hysteroscopic
niche
excision, 67 were included in the study while the remaining were lost to follow-up. Patient's mean age at procedure was 38±5.5. Twenty-nine patients (43%) had an history of high order repeat cesarean surgeries. Sixty-six patients (98.5%) presented with post menstrual bleeding, 26 with
secondary infertility(38.8%) and 2 with
pelvic pain(2.9%). Following hysteroscopic
niche
excision, 63.4% of patients reported significant improvement or resolution of post menstrual bleeding. A statistically significant reduction in number of bleeding days per cycle (15.5±4.8 vs. 9.8±4.7, P Conclusion Extensive hysteroscopic surgical
excisionof cesarean scar
nicheshould be considered in symptomatic patients suffering from irregular menstrual bleeding. The quality of the
excisionat the apex of the
nichecould be associated with a higher success rate. The role of
niche
excisionto overcome
secondary infertilityshould be further evaluated.
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