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• W2622933470 abstract "Study Objective To demonstrate a new technique of isthmocele repair via laparoscopic surgery. Design Case report (Canadian Task Force classification III). The local Ethics Committee waived the requirement for approval. Setting Isthmocele localized at a low uterine segment is a defect of a previous caesarean scar due to poor myometrial healing after surgery [ 1 Gubbini G. Casadio P. Marra E. Resectoscopic correction of the isthmocele in women with postmenstrual abnormal uterine bleeding and secondary infertility. J Minim Invasive Gynecol. 2008; 15: 172-175 Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar ]. This pouch accumulates menstrual bleeding, which can cause various disturbances and irregularities, including abnormal uterine bleeding, infertility, pelvic pain, and scar pregnancy [ 2 Belinda Centeio L. Scapinelli A. Depes D. et al. Findings in patients with postmenstrual spotting with prior cesarean section. J Minim Invasive Gynecol. 2010; 17: 361-364 Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar , 3 Fabres C. Aviles G. De La Jara C. et al. The cesarean delivery scar pouch: clinical implications and diagnostic correlation between transvaginal sonography and hysteroscopy. J Ultrasound Med. 2003; 22: 695-700 Crossref PubMed Scopus (141) Google Scholar , 4 Wang C.B. Chiu W.W. Lee C.Y. et al. Cesarean scar defect: correlation between cesarean section number, defect size, clinical symptoms and uterine position. Ultrasound Obstet Gynecol. 2009; 34: 85-89 Crossref PubMed Scopus (191) Google Scholar , 5 Donnez O. Jadoul P. Squifflet J. Donnez J. Laparoscopic repair of wide and deep uterine scar dehiscence after cesarean section. Fertil Steril. 2008; 89: 974-980 Abstract Full Text Full Text PDF PubMed Scopus (93) Google Scholar , 6 Gubbini G. Centini G. Nascetti D. et al. Surgical hysteroscopic treatment of cesarean-induced isthmocele in restoring fertility: prospective study. J Minim Invasive Gynecol. 2011; 18: 234-237 Abstract Full Text Full Text PDF PubMed Scopus (123) Google Scholar ]. Given the absence of a clearly defined surgical method in the literature, choosing the proper approach to treating isthmocele can be arduous. Laparoscopy provides a minimally invasive procedure in women with previous caesarean scar defects. Intervention A 28-year-old woman, gravida 2 para 2, presented with a complaint of prolonged postmenstrual bleeding for 5 years. She had undergone 2 cesarean deliveries. Transvaginal ultrasonography revealed a hypoechogenic area with menstrual blood in the anterior lower uterine segment. Magnetic resonance imaging showed an isthmocele localized at the anterior left lateral side of the uterus, with an estimated volume of approximately 12 cm3. After patient preparation, laparoscopy was performed. To repair the defect, the uterovesical peritoneal fold was incised and the bladder was mobilized from the lower uterine segment. During this surgery, differentiating the isthmocele from the abdomen can be challenging. Here we used a Foley catheter to identify the isthmocele. To do this, after mobilizing the bladder from the lower uterine segment, we inserted a Foley catheter into the uterine cavity through the cervical canal. We then filled the balloon of the catheter at the lower uterine segment under laparoscopic view, which allowed clear identification of the isthmocele pouch. The uterine defect was then incised. The isthmocele cavity was accessed, the margins of the pouch were debrided, and the edges were surgically reapproximated with continuous nonlocking single layer 2-0 polydioxanone sutures. We believed that single-layer suturing could provide for proper healing without necrosis due to suturation. During the procedure, the vesicouterine space was dissected without difficulty. A urine bag was collected with clear urine, and there was no gas leakage; thus, we considered a safety test for the bladder superfluous. Based on concerns about the possible increased risk of adhesions, we did not cover peritoneum over the suture. The patients experienced no associated complications, and she reported complete resolution of prolonged postmenstrual bleeding at a 3-month follow-up. Conclusion Even though the literature is cloudy in this area, a laparoscopic approach to repairing an isthmocele is a safe and minimally invasive procedure. Our approach described here involves inserting a Foley catheter in the uterine cavity through the cervical canal, then filling the balloon in the lower uterine segment under laparoscopic view to identify the isthmocele." @default.
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• W2622933470 date "2018-01-01" @default.
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• W2622933470 title "Determination of Isthmocele Using a Foley Catheter During Laparoscopic Repair of Cesarean Scar Defect" @default.
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• W2622933470 doi "https://doi.org/10.1016/j.jmig.2017.05.017" @default.
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