Gumusburun Neset, Uskent Ulya
Tokat Gaziosmanpasa University Hospital, Department of Obstetrics and Gynecology - Tokat, Türkiye.
Gayrettepe Florence Nightingale Hospital, Department of Obstetrics and Gynecology - İstanbul, Türkiye.
Rev Assoc Med Bras (1992). 2025 May 2;71(3):e20241507. doi: 10.1590/1806-9282.20241507. eCollection 2025.
Isthmocele or cesarean scar defect is a pouch-like defect in the myometrium at the isthmic level that is thought that it might occur as a result of the insufficient healing process of the uterine incision after cesarean section. It is important not to underestimate isthmocele and its preventive measures since it might cause serious gynecologic and obstetric complications. However, the best suturing technique suitable for the prevention of isthmocele formation is yet to be identified. The aim of this study was to compare the effects of three different uterine closure techniques applied during cesarean section on isthmocele formation.
In this prospective study, a total of 120 term (>37 weeks) pregnant women with no history of cesarean section and scheduled for primary cesarean section were randomized preoperatively to three different uterotomy closure techniques (baseball, single-locked, and single-unlocked groups).
In a total of 43 patients, postoperative third-month sonography revealed isthmocele as an anechoic triangular area with ≥1 mm depth at the scar site. Compared with the single-locked and single-unlocked groups, isthmocele development was significantly lower in the baseball-type closure group (47.5% in the single-locked, 46.2% in the single-unlocked, and 15.4% in the baseball-type closure group). The group with the highest residual myometrial thickness, that is, 5.7 mm, was again the patients who underwent baseball sutures.
Uterotomy closure with baseball-type suturing seems to be an advantageous method as compared to the traditional techniques in terms of preserving the residual myometrial thickness and preventing isthmocele formation.
峡部憩室或剖宫产瘢痕缺损是指峡部水平子宫肌层的袋状缺损，被认为可能是剖宫产术后子宫切口愈合过程不充分所致。不要低估峡部憩室及其预防措施，因为它可能导致严重的妇产科并发症。然而，尚未确定最适合预防峡部憩室形成的缝合技术。本研究的目的是比较剖宫产术中应用的三种不同子宫关闭技术对峡部憩室形成的影响。
在这项前瞻性研究中，共有120例无剖宫产史且计划行初次剖宫产的足月（>37周）孕妇在术前被随机分为三种不同的子宫切开术关闭技术组（棒球缝合法、单锁缝合法和单解锁缝合法组）。
共有43例患者在术后第三个月的超声检查中显示峡部憩室为瘢痕部位深度≥1mm的无回声三角形区域。与单锁缝合法组和单解锁缝合法组相比，棒球缝合法关闭组的峡部憩室发生率显著更低（单锁缝合法组为47.5%，单解锁缝合法组为46.2%，棒球缝合法关闭组为15.4%）。残余子宫肌层厚度最高的组，即5.7mm，同样是接受棒球缝合法缝合的患者。
与传统技术相比，棒球缝合法进行子宫切开术关闭在保留残余子宫肌层厚度和预防峡部憩室形成方面似乎是一种更具优势的方法。
