The effect of laparoscopic resection of large niches in the uterine caesarean scar on symptoms, ultrasound findings and quality of life: a prospective cohort study

Objective To evaluate the effectiveness of a laparoscopic niche resection on niche related symptoms and/or fertility related problems, ultrasound findings and quality of life. Design Prospective cohort study. Setting University hospital. Population Women with a large niche (residual myometrium (RM) <3 mm) and complaints of either postmenstrual spotting, dysmenorrhea, intrauterine fluid accumulation and/or difficulties with embryo transfer due to distorted anatomy. Methods Women filled out questionnaires and a validated menstrual score chart at baseline and six months after the laparoscopic niche resection. At baseline and between three to six months follow-up niches were evaluated by transvaginal ultrasound Main outcome measures The primary outcome was reduction of the main problem six months after the intervention. Secondary outcomes were complications, menstrual characteristics, dysmenorrhea, niche measurements, intrauterine fluid, surgical outcomes, satisfaction and quality of life. Results 101 women underwent a laparoscopic niche resection. In 80 women (79.2%) the main problem was improved or resolved. Postmenstrual spotting was reduced statistically significant with 7 days at six months follow-up compared to baseline. Dysmenorrhea and discomfort related to spotting reduced statistically significant as well. The RM increased statistically significant at follow-up. The intrauterine fluid was resolved in 86.9% of the women with intra-uterine fluid at baseline. 83.3% of women were (very) satisfied. The physical component of quality of life increased, the mental component did not change. Conclusions A laparoscopic niche resection reduced postmenstrual spotting, discomfort due to spotting, dysmenorrhea and the presence of intrauterine fluid in the majority of women and increased the RM. This article is protected by copyright. All rights reserved.