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. Journal of Minimally Invasive Gynecology (2012) 19, 454-458 (C) 2012 AAGL. All rights reserved.