Laparoscopic Repair of Cesarean Scar Defect "Isthmocele"

This is demonstration of laparoscopic repair of cesarean scar defect "Isthmocele". The presence of a uterine dehiscence or isthmocle may explain some gynecological symptoms. The presence of an isthmocoele or diverticulum in the uterine scar could lead to retention of menstrual blood by two mechanisms, the first by the existence of this pocket and the second by a valve effect caused by the lower edge of this diverticulum which would hinder the spontaneous evacuation of the rules. At the level of this diverticulum, there are several phenomena secondary to the accumulation of blood; Congestive endometrium, polyps, lymphocytic infiltration, reactions to suture material, atypical vascularization. This accumulation of blood would be responsible for persistent bleeding after menstruation, menorrhagia, chronic pelvic inflammatory states, secondary infertility. Its impact is unknown as this entity is still being discussed. Risk Factors Level of hysterotomy. Performing hysterotomy that is too low or too high is responsible for poor quality of scarring. Performing Caesarean section outside of labor, infection, suture quality. Diagnosis can be ultrasound, but most often the diagnosis is made by hysteroscopy, evidence, beyond the cervix, of an uterine defect more or less filled with necrotic or fibrinous tissues attesting the accumulation of blood. Access to this defect is often hampered by the lower edge of the isthmoclele. MRI is of particular interest in assessing the remaining thickness of myometrium in relation to isthmocoele. Treatment several treatments have been proposed. Laparoscopic or vaginal treatment is possible. It requires wide resection and reconstruction. This technique should be favored for isthmocoves responsible for obstetric accidents. Hysteroscopic treatments. When it is not necessary to strengthen the scar, it seems more logical to propose this approach. The aim of this technique is to evacuate the contents of the diverticulum, remove any foreign matter, coagulate the surface to treat abnormalities of the endometrium and abnormal vascularity, and especially to resect the banks in order to obtain a softer slope Between the bottom of the diverticulum and the rest of the wall. The results reported by different teams are very interesting regarding the treatment of postmenopausal bleeding or menorrhagia. This procedure is performed at the clinic in Rabat, Morocco (www.lacapitalemaroc.com).