Objective
To study the effect of the surgical repair (isthmorraphy) of the large scar dehiscence after cesarean on symptoms and fertility for women who desire pregnancy.
Patients and methods
In this retrospective study, 14聽symptomatic patients, who desire a new pregnancy underwent a surgical repair by laparotomy, laparoscopic or vaginal technique. Five women experienced failure of Assistance Reproductive Technique (IVF or ICSI) for idiopathic secondary infertility. The dehiscent scars were evaluated by ultrasound, hysterography, hysteroscopy and magnetic resonance imaging.
Outcome
Symptoms improvement was found in 92% of case. Ten pregnancy (71%) was obtained after surgical repair, 6聽spontaneous and 4聽after Assistance Reproductive Technique. Among the 5聽women initially followed in the reproductive unit, 4聽became pregnant, 3 after IVF or ICSI and 1聽spontaneous. No operative complication occurred. The subsequent pregnancy was unremarkable with no uterine rupture.
Discussion
Large scar defect after cesarean can take shape of a complete absent of the anterior wall of the uterus. No incident has been proved in this condition. There is a lack of data concerning these isthmocele. The experience of hysteroscopic repair cannot be applied to these real large diverticule of the scar cesarean. The results of this study suggest a link between the isthmocele and reversible symptoms after surgery. The first results concerning the subsequent fertility after surgical repair seem interesting
Conclusion
When a large scare defect (isthmocele) is found in symptomatic woman (pelvic pain, bleeding uterine, infertility), a surgical repair can be proposed, especially for woman who desire a new pregnancy
