Page 16 - World Journal of Laparoscopic Surgery

Roshan Zeirideen Zaid
In the hysteroscopy procedure, the surface is coagu- sarean uterine scars? Hypotheses on the aetiology of niche
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lated, distal rim resected, 24,30,31 or polyps removed. The development. Hum Reprod 2015 Dec;30(12):2695-2702.
randomized controlled trial (RCT) by Vevroot compared 9. Florioa P, Filippeschi M, Moncinia I, Marrac E, Franchinid M,
hysteroscopy with other methods in the control group Gubbini G. Hysteroscopic treatment of the cesarean-induced
isthmocele in restoring infertility. Curr Opin Obstet Gynecol
(Combined oral contraceptive pills (COC), Intrauterine 2012 Mar;24(3):180-186.
device (IUD), and hysterectomy). They concluded that this 10. Chazotte C, Cohen WR. Catastrophic complications of previ-
is not good for defects that are too thin (less than 3 mm) ous cesarean section. Am J Obstet Gynecol 1990 Sep;163(3):
since the bladder injury/perforation is too high; also this 738-742.
cannot be used for niches more than 5 mm. They found 11. Clark SL, Koonings PP, Phelan JP. Placenta previa/accreta and
prior cesarean section. Obstet Gynecol 1985 Jul;66(1):89-92.
that quality of life and sex life improved following the 12. OuYang Z, Yin Q, Xu Y, Ma Y, Zhang Q, Yu Y. Heterotopic
procedure; they have not looked into the fertility outcome. cesarean scar pregnancy: Diagnosis, treatment, and progno-
Also hysteroscope has the capacity to only coagulate the sis. J Ultrasound Med 2014 Sep;33(9):1533-1537.
superficial vessels, not the deep ones, so possibility of 13. Perez-Medina T, Sancho-Sauco J, Rios M, Pereira A, Argila N,
recurrence or converting to open or laparoscopy surgery Cabezas E, Cayuela E. Hysteroscopy in pregnancy-related
is always there if the bleeding becomes heavy. Prospec- conditions: Descriptive analysis in 273 patients. J Minim
Invasive Gynecol 2014 May-Jun;21(3):417-425.
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tive and retrospective studies done by Gubbins et al , 14. Thurmond AS, Harvey WJ, Smith SA. Cesarean section scar
Fabres et al 24,33 and many others state possible improve- as a cause of abnormal vaginal bleeding: Diagnosis by sono-
ment of fertility. All studies that show improvement in hysterography. J Ultrasound Med 1999 Jan;18(1):13-16.
fertility following hysteroscopic treatment have a very 15. Poidevin LO. The value of hysterography in the prediction of
small sample size. cesarean section wound defects. Am J Obstet Gynecol 1961
Jan;81:67-71.
16. Morris H. Surgical pathology of the lower uterine segment
ConCLuSIon caesarean section scar: Is the scar a source of clinical symp-
A common terminology and definition is needed for toms? Int J Gynecol Pathol 1995 Jan;14(1):16-20.
this defect in the myometrium following hysterotomy. 17. Schepker N, Garcia-Rocha GJ, von Versen-Höynck F, Hil-
lemanns P, Schippert C. Clinical diagnosis and therapy of
We need more RCT in order to assess the best treatment uterine scar defects after caesarean section in non-pregnant
options. As opposed to hysteroscopy, in laparoscopy the women. Arch Gynecol Obstet 2015 Jun;291(6):1417-1423.
defect explored, fibrous tissue excised, and the defect in 18. Wang CB, Chiu WW, Lee CY, Sun YL, Lin YH, Tseng CJ.
the myometrium is closed, hence functional and anatomi- Cesarean scar defect: Correlation between cesarean section
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cal aspects of the niche are restored. Symptoms vanish, number, defect size, clinical symptoms and uterine position.
Ultrasound Obstet Gynecol 2009 Jul;34(1):85-89.
fertility restored, and the potential future problems 19. Regnard C, Nosbusch M, Fellemans C, Benali N, van Rys-
negated. Hence, with the available current evidence, selberghe M, Barlow P, Rozenberg S. Cesarean section scare
laparoscopy is the way forward to correct the niche. valuation by saline contrast sonohysterography. Ultrasound
Obstet Gynecol 2004 Mar;23(3):289-292.
REFEREnCES 20. van der Voet LF, Bij de Vaate AM, Veersema S, Brölmann HA,
Huirne JA. Long-term complications of caesarean section.
1. The Forbes. Which countries have the highest caesarean The niche in the scar: A prospective cohort study on niche
section rates? 2016 Jan. prevalence and its relation to abnormal uterine bleeding.
2. Roberts CL, Nippita TA. International caesarean section rates: BJOG 2014 Jan;121(2):236-244.
The rising tide. Lancet 2015 May;3(5):241-242. 21. Tower AM, Frishman GN. Cesarean scar defects: An under-
3. Clark EA, Silver RM. Long-term maternal morbidity associ- recognized cause of abnormal uterine bleeding and other
ated with repeat cesarean delivery. Am J Obstet Gynecol 2011 gynecologic complications. JMIG 2013 Sep-Oct;20(5):562-572.
Dec;205(6 Suppl):S2-S10. 22. Osser Vikhareva O, Valentin L. Risk factors for incomplete
4. Silver RM. Delivery after previous cesarean: Long-term healing of the uterine incision after caesarean section. BJOG
maternal outcomes. Semin Perinatol 2010 Aug;34(4):258-266. 2010 Aug;117(9):1119-1126.
5. Monteagudo A, Carreno C, Timor-Tritsch IE. Saline infusion 23. Marotta M-L, Donnez J, Squifflet J, Jadoul P, Darii N, Donnez O.
sonohysterography in nonpregnant women with previous Laparoscopic repair of post-cesarean section uterine scar
cesarean delivery: The “niche” in the scar. J Ultrasound Med defects diagnosed in nonpregnant women. J Minim Invasive
2001 Oct;20(10):1105-1115. Gynecol 2013 Jan;20(3):386-391.
6. Masuda H, Uchida H, Maruyama T, Sato K, Sato S, Tanaka M. 24. Fabres C, Aviles G, De La Jara C, Escalona J, Muñoz JF,
Successful treatment of atypical cesarean scar defect using Mackenna A, Fernández C, Zegers-Hochschild F, Fernández
endoscopic surgery. BMC Pregnancy Childbirth 2015;15:342. E. The cesarean delivery scar pouch: Clinical implications
7. Nezhat C, Grace L, Soliemannjad R, Razavi GM, Nezhat A. and diagnostic correlation between transvaginal sono-
Cesarean scar defect: What is it and how should it be treated? graphy and hysteroscopy. J Ultrasound Med 2003 Jul;22(7):
OBG Manage 2016 April;28(4):32. 695-700.
8. Vervoort AJ, Uittenbogaard LB, Hehenkamp WJK, Brölmann 25. Ida A, Kubota Y, Nosaka M, Ito K, Kato H, Tsuji Y. Successful
HAM, Mol BWJ, Huirne JAF. Why do niches develop in Cae- management of a cesarean scar defect with dehiscence of the
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