Efficacy and safety of different operation methods for patients with cesarean scar diverticulum_Chinese Journal of Evidence-Based Medicine

Authors：

YU Chuanrong ¹ ,  LOU Jiangyan ² , CAO Hanyu ² , DENG Liyun ²

1. Department of Gynecology and Obstetrics, Chengdu Second People's Hospital, Chengdu, 610017, P.R.China;
2. Department of Gynecology, West China Second University Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding?author：

LOU Jiangyan, Email: 724014591@qq.com

Keywords：

Cesarean section; Cesarean section diverticulum; Hysteroscopy; Laparotomy; Hysteroscopy combined with laparoscopy; Laparoscopy; Vaginal surgery

DOI：

10.7507/1672-2531.201803043

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Objectives To analyze the efficacy and safety of different operation methods for patients with cesarean scar diverticulum. Methods The clinical data of patients with cesarean section scar diverticulum treated in West China Second University Hospital from July 2012 to December 2016 was collected and followed up. The data of the previous perioperative period data, recovery, the improvement of the symptoms and postoperative condition of incision healing were analyzed by SPSS 22.0 software. Results A total of 125 patients were included, in which 74 cases received hysteroscopy surgery for diverticulum electro section and electric coagulation (ESEC group), and 51 cases received other surgery focused on diverticulum dissection and sewing operations (DS group). Statistical analysis showed that, compared with DS group, bleeding, operation time, time of anal exsufflation and hospitalization duration after the operation of hysteroscopy in ESEC group were significantly reduced (P<0.001). In addition, the results showed that hysteroscopy group had optimal results in hemorrhage volume, operation time, anal exhaust time and hospitalization time indicators. However, the results of laparotomy group was not significant. Conclusions For the treatment of CSD, surgical treatment of this pathology by operative hysteroscopy may represent the best choice in symptomatic women because of its minimal invasiveness and beneficial therapeutic results. Hysteroscopy isthmoplasty appears to be the most popular treatment.

Citation： YU Chuanrong, LOU Jiangyan, CAO Hanyu, DENG Liyun. Efficacy and safety of different operation methods for patients with cesarean scar diverticulum. Chinese Journal of Evidence-Based Medicine, 2018, 18(12): 1292-1296. doi: 10.7507/1672-2531.201803043 Copy

1.	Zhang J, Liu Y, Meikle S, et al. Cesarean delivery on maternal request in southeast China. Obstet Gynecol, 2008, 111(5): 1077-1082.
2.	Bij de Vaate AM, van der Voet LF, Naji O, et al. Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following cesarean section:systematic review. Ultrasound Obstet Gynecol, 2014, 43(4): 372-382.
3.	Osser OV, Jokubkiene L, Valentin L. High prevalence of defects in cesarean section scars at transvaginal ultrasound examination. Ultrasound Obstet Gynecol, 2009, 34(1): 90-97.
4.	Florio P, Filippeschi M, Moncini I, et al. Hysteroscopic treatment of the cesarean-induced isthmocele in restoring infertility. Curr Opin Obstet Gynecol, 2012, 24(3): 180-186.
5.	Mah MW, Pyper AM, Oni GA, et al. Impact of antibiotic prophylaxis on wound infection after cesarean section in a situation of expected higher risk. Am J Infect Control, 2001, 29(2): 85-88.
6.	Donnez O, Jadoul P, Squifflet J, et al. Laparoscopic repair of wide and deep uterine scar dehiscence after cesarean section. Fertil Steril, 2008, 89(4): 974-980.
7.	van der Voet LF, Bij de Vaate AM, Veersema S, et al. Long-term complications of caesarean section. The niche in the scar: a prospective cohort study on niche prevalence and its relation to abnormal uterine bleeding. BJOG, 2014, 121(2): 236-244.
8.	Tulandi T, Cohen A. Emerging manifestations of cesarean scar defect in reproductive-aged women. J Minim Invasive Gynecol, 2016, 23(6): 893-902.
9.	Futyma K, Ga?czyński K, Romanek K, et al. When and how should we treat cesarean scar defect - isthmocoele? Ginekol Pol, 2016, 87(9): 664-668.
10.	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(2): 234-237.

1. Zhang J, Liu Y, Meikle S, et al. Cesarean delivery on maternal request in southeast China. Obstet Gynecol, 2008, 111(5): 1077-1082.
2. Bij de Vaate AM, van der Voet LF, Naji O, et al. Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following cesarean section:systematic review. Ultrasound Obstet Gynecol, 2014, 43(4): 372-382.
3. Osser OV, Jokubkiene L, Valentin L. High prevalence of defects in cesarean section scars at transvaginal ultrasound examination. Ultrasound Obstet Gynecol, 2009, 34(1): 90-97.
4. Florio P, Filippeschi M, Moncini I, et al. Hysteroscopic treatment of the cesarean-induced isthmocele in restoring infertility. Curr Opin Obstet Gynecol, 2012, 24(3): 180-186.
5. Mah MW, Pyper AM, Oni GA, et al. Impact of antibiotic prophylaxis on wound infection after cesarean section in a situation of expected higher risk. Am J Infect Control, 2001, 29(2): 85-88.
6. Donnez O, Jadoul P, Squifflet J, et al. Laparoscopic repair of wide and deep uterine scar dehiscence after cesarean section. Fertil Steril, 2008, 89(4): 974-980.
7. van der Voet LF, Bij de Vaate AM, Veersema S, et al. Long-term complications of caesarean section. The niche in the scar: a prospective cohort study on niche prevalence and its relation to abnormal uterine bleeding. BJOG, 2014, 121(2): 236-244.
8. Tulandi T, Cohen A. Emerging manifestations of cesarean scar defect in reproductive-aged women. J Minim Invasive Gynecol, 2016, 23(6): 893-902.
9. Futyma K, Ga?czyński K, Romanek K, et al. When and how should we treat cesarean scar defect - isthmocoele? Ginekol Pol, 2016, 87(9): 664-668.
10. 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(2): 234-237.

Chinese Journal of Evidence-Based Medicine

Efficacy and safety of different operation methods for patients with cesarean scar diverticulum

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