Through the last decades and as a
consequence to the changing obstetrical
strategies, a rising rate of cesarean
deliveries has been reported in literature
reviews worldwide. The percentage of
cesarean sections ranges from 23% to 30%
reaching up to 50% in the United States.
Cesarean delivery can have a major and
long lasting sequela on the patient. In case
of an incorrect wound healing process there
is a risk of a persistent uterine wall defect,
isthmocele or niche also named cesarean
scar diverticulum or pouch. Cesarean Scar
Defect (CSD) is being reported in the recent
literature with a variable incidence ranging
from 24 to 84%. Several symptoms have
been related to Cesarean Scar Defect (CSD)
syndrome such as [1, 2, 3]:
• Abnormal Uterine Bleeding (AUB):
Inter menstrual Bleeding, post menstrual
spotting, prolonged menstruation or
continuous brown discharge.
• Dymenorrhea and Dyspareunia.
• Chronic Pelvic Pain.
• Secondary Infertility.
• Higher risk complications during
subsequent pregnancy such as cesarean
scar pregnancy, dehiscence, placenta previa
•Difficulty with gynecologic procedures
like uterine evacuation, hysteroscopy and
intrauterine device insertion.
Guidelines for treatment of the CSD are
unclear[1-11]. The surgical treatment
has garnered interest in the minimally
invasive gynecologic surgery. Surgical
management options include: transvaginal
repair, hysteroscopic excision, laparoscopic
repair and recently the combined use
of hysteroscopy and laparoscopy for the
isthmocele treatment [1-10]. This article
presents our experience with isthmocele
treatment. Through the description of the
corrective surgery method we intend to
report the feasibility and effectiveness of the
combined laparoscopic and hysteroscopic
technique for the CSD repair..