Olivier Donnez1, Jacques Donnez2, Renan Orellana3, Marie-Madeleine Dolmans4. 1. Institut du Sein et de Chirurgie Gynécologique d'Avignon, Polyclinique Urbain V (Groupe Elsan), Avignon, France; Pôle de Recherche en Gynécologie, IREC Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium. Electronic address: pr.olivier.donnez@gmail.com. 2. Society for Research into Infertility, Brussels, Belgium. 3. Pôle de Recherche en Gynécologie, IREC Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium. 4. Pôle de Recherche en Gynécologie, IREC Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Gynecology Department, Cliniques Universitaires Saint Luc, Brussels, Belgium.
Abstract
OBJECTIVE: To evaluate gynecological and obstetrical outcomes, as well as remaining myometrial thickness, after laparoscopic repair of a cesarean scar. DESIGN: Observational study and prospective evaluation of the remaining myometrium before and after repair. SETTING: Academic department in a university hospital. PATIENT(S): A series of 38 symptomatic women with cesarean scar defects and remaining myometrial thickness of less than 3 mm, according to magnetic resonance imaging. INTERVENTION(S): Laparoscopic repair of the defect. MAIN OUTCOMES MEASURE(S): Increase in myometrial thickness at the site of cesarean section, gynecological and obstetrical outcomes, and histological analysis of the defect after excision. RESULT(S): The mean thickness of the myometrium increased significantly from 1.43 ± 0.7 mm before surgery to 9.62 ± 1.8 mm after surgery. All but three patients were free of symptoms. Among the 18 women with infertility, eight (44%) became pregnant and delivered healthy babies by cesarean section at 38-39 weeks of gestation. Histological analysis, performed in all 38 cases, revealed the presence of endometriosis in eight women (21.1%). Muscle fiber density was significantly lower compared with adjacent myometrium. CONCLUSION(S): In symptomatic women with residual myometrial thickness of less than 3 mm who wish to conceive, laparoscopic repair could be considered an appropriate approach.
OBJECTIVE: To evaluate gynecological and obstetrical outcomes, as well as remaining myometrial thickness, after laparoscopic repair of a cesarean scar. DESIGN: Observational study and prospective evaluation of the remaining myometrium before and after repair. SETTING: Academic department in a university hospital. PATIENT(S): A series of 38 symptomatic women with cesarean scar defects and remaining myometrial thickness of less than 3 mm, according to magnetic resonance imaging. INTERVENTION(S): Laparoscopic repair of the defect. MAIN OUTCOMES MEASURE(S): Increase in myometrial thickness at the site of cesarean section, gynecological and obstetrical outcomes, and histological analysis of the defect after excision. RESULT(S): The mean thickness of the myometrium increased significantly from 1.43 ± 0.7 mm before surgery to 9.62 ± 1.8 mm after surgery. All but three patients were free of symptoms. Among the 18 women with infertility, eight (44%) became pregnant and delivered healthy babies by cesarean section at 38-39 weeks of gestation. Histological analysis, performed in all 38 cases, revealed the presence of endometriosis in eight women (21.1%). Muscle fiber density was significantly lower compared with adjacent myometrium. CONCLUSION(S): In symptomatic women with residual myometrial thickness of less than 3 mm who wish to conceive, laparoscopic repair could be considered an appropriate approach.
Authors: Ana Vegas Carrillo de Albornoz; Irene López Carrasco; Nerea Montero Pastor; Carmen Martín Blanco; María Miró Matos; Luis Alonso Pacheco; Enrique Moratalla Bartolomé Journal: Int J Fertil Steril Date: 2019-04-27
Authors: Kristen H Kjerulff; Ian M Paul; Carol S Weisman; Marianne M Hillemeier; Ming Wang; Richard S Legro; John T Repke Journal: JAMA Netw Open Date: 2020-04-01