Vaginal Repair of Cesarean Section Scar Diverticula that Resulted in Improved Postoperative Menstruation.
STUDY OBJECTIVE Owing to the increase in cesarean sections (C sections) worldwide, long term complications such as postmenstrual spotting, chronic pelvic pain, and C section scar ectopic pregnancies have created a new medical era of gynecologic disease. A new type of vaginal repair is evaluated to repair C section diverticulum (CSD) and rebuild the muscular layer to improve symptoms of abnormal uterine bleeding and decrease the risk of uterine rupture. DESIGN Retrospective cohort study (Canadian Task Force classification II 2) SETTING University hospital. PATIENTS A total of 121 patients with CSD diagnoses by transvaginal ultrasound (TVU) presented with postmenstrual spotting between June 2012 and March 2015. All patients had undergone at least 1 C section delivery and had no history of postmenstrual spotting before undergoing C section. INTERVENTION Vaginal excision and suture of CSD. MEASUREMENT AND MAIN RESULTS The mean duration of menstruation was 14.87 3.46 days preoperatively and decreased to 8.22 2.73 days at 1 month after surgery, 8.89 2.67 days at 3 months after surgery, and 9.02 2.47 days at 6 months after surgery (p .01) The length, width, depth, and thickness of the remaining muscular layer (TRM) at 1 month, 3 months, and 6 months assessed by TVU also improved significantly after surgery (p .05) However, postoperative menstruation and imaging data did not differ markedly between 3 months and 6 months, suggesting that follow up at 3 months represents an adequate endpoint for evaluating the effectiveness of surgery. At 6 months, 80.3% of patients (94 of 117) reached =10 days of menstruation. Further study revealed that a TRM at 6 months of =8.5 mm measured by TVU (relative risk [RR] 6.418; 95% confidence interval [CI] 1.478 28.443) and an interval between CS and vaginal repair of =2.5 years (RR, 12.0; 95% CI, 1.541 93.454) were good prognostic factors associated with surgery. CONCLUSION Vaginal repair of CSD improved the symptoms of postmenstrual spotting and anatomically corrected the scars. An interval between C section and a surgery of =2.5 years was optimal for vaginal repair, and a TRM at 6 months of =8.5 mm represented the standard healing of CSD.
Journal of minimally invasive gynecology