Vaginal repair of cesarean section scar diverticula.

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.