These procedures are done in symptomatic patients who have finished their child bearing. The principle is to make the area shallow. Defects are almost perpendicular towards caudal end in all. Principle of surgery is to make defect shallow towards caudal end only. Nothing is done at uterine opening. Defects are anterior extending towards on side (rt or Lt) or they extend both sides.Pre operative assessment of volume of isthmocele and RMT is required. At times polyps and hyperplastic endometrium in these areas also additionally required. In case of large defects dysmenorrhoea without other associated uterine pathology may be present. Isthmocele is preoperative diagnosis.
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