Hysteroscopy Versus Laparoscopy in the Management of Isthmocele: A Review of the Literature.
Isthmocele is a pouch defect of the anterior uterine wall, detected at the site of the previous cesarean scar. It can be asymptomatic or cause abnormal uterine bleeding, pelvic discomfort and difficulty conceiving. The main objective of this review is to highlight .the hysteroscopic and laparoscopic approaches in the management of this disorder.
Cesarean section, the most common surgical procedure performed worldwide, has been linked to several obstetrical and gynecological complications. Stemming from an incongruent post-operative healing of the lower uterine segment, multiple consequences may complicate future gynecological or obstetrical outcomes. They include but are not limited to placenta accreta, scar dehiscence, cesarean-scar ectopic pregnancy, and isthmocele.
Isthmocele, also known as uterine niche, cesarean scar defect or cesarean scar syndrome, is a pouch defect of the anterior uterine wall, detected at the site of the previous cesarean scar. Despite the fact that many women with this defect may be asymptomatic, others might present with a wide range of complaints, including intermittent spotting or bleeding, pelvic discomfort and /difficult conceiving.
Another study evaluated the myometrial thickness before and after the procedure using MRI. It showed that the mean thickness increased significantly from 2.1 mm before the resection to
4.2 mm after the surgery.13 And since residual myometrial thickness of less than 2 mm is associated with a significant increase in the risk of uterine rupture, this technique should theoretically be associated with decreased possibility of a uterine rupture during subsequent trials of labor.
Women Health Open J. 2019; 5(1): 6-11. doi: 10.17140/WHOJ-5-130
