Vaginal Repair of Cesarean Section Scar Diverticula

Study ObjectiveTo 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.DesignRetrospective clinical study (Canadian Task Force classification II-3).SettingUniversity-affiliated hospital.PatientsData 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.InterventionsHysteroscopy 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 ResultsThe 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).ConclusionVaginal repair is a minimally invasive and effective surgical approach for treatment of uterine scar diverticula associated with previous cesarean section.