Gynecological and obstetrical outcomes after laparoscopic repair of a cesarean scar defect in a series of 38 women

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• 作者：Olivier Donnez ; M.D. ; Ph.D.^a ; ^b ; ^{pr.olivier.donnez@gmail.com} ; Jacques Donnez ; M.D. ; Ph.D.^c ; Renan Orellana ; Ph.D.^b ; Marie-Madeleine Dolmans ; M.D. ; Ph.D.^b ; ^d
• 关键词：Cesarean scar defect ; niche ; laparoscopic repair ; hysteroscopy ; myometrial thickness
• 刊名：Fertility and Sterility
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：107
• 期：1
• 页码：289-296.e2
• 全文大小：1801 K
• 卷排序：107

文摘

To evaluate gynecological and obstetrical outcomes, as well as remaining myometrial thickness, after laparoscopic repair of a cesarean scar.DesignObservational study and prospective evaluation of the remaining myometrium before and after repair.SettingAcademic 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.