Vaginal repair of cesarean section scar diverticula

Abstract

Study objective: To introduce a new vaginal surgery for repair of cesarean scar diverticula and to evaluate the effectiveness of this treatment for correcting the anatomic defect and eliminating abnormal uterine bleeding.

Design: Retrospective clinical study (Canadian Task Force classification II-3).

Setting: University-affiliated hospital.

Patients: Data for 42 patients were reviewed retrospectively. All patients had abnormal uterine bleeding, prolonged menstrual flow, and/or postmenstrual spotting. The diagnosis of a cesarean scar diverticulum of the uterus was established using transvaginal ultrasound.

Interventions: Hysteroscopy was performed to visualize the defect if necessary. Vaginal repair involved excision of the scar and surrounding tissue, followed by closure using 2 layers of sutures.

Measurements and main results: The median (range) duration of surgery was 60 (30-120) minutes; blood loss during surgery was 45 (10-100) mL; length of hospital stay was 3 (2-11) days. Perioperative complications occurred in 1 of 42 patients (2.4%). Follow-up ranged from 10 to 23 months. The efficacy of anatomic correction and rate of symptomatic relief was 92.9% (39 of 42 patients).

Conclusion: Vaginal repair is a minimally invasive and effective surgical approach for treatment of uterine scar diverticula associated with previous cesarean section.