What is the Role of Laparoscopic Surgery for Cesarean Scar Pregnancy?
| Discussion in 'All Categories' started by Dr. Sara - Jun 4th, 2021 8:13 am. | |
Dr. Sara
|
I have a patient suffering from a cesarean scar. I want to perform laparoscopic surgery. Please guide us should I perform this surgery by open or we should do it laparoscopy. |
|
re: What is the Role of Laparoscopic Surgery for Cesarean Scar Pregnancy?
by Dr. Rahul -
Jun 4th, 2021
8:41 am
#1
|
|
Dr. Rahul
|
Cesarean scar pregnancy is a type of ectopic pregnancy that may occur as a rare and peculiar complication in the subsequent pregnancy following Cesarean Section, which is characterized by the implantation of the gestational sac into the previous hysterotomy scar. Over the last two decades, with the increasing rate of cesarean section in clinical and the improvement in imaging and diagnostic technology, the morbidity of this rare pregnancy has been resultantly escalating. It was estimated that 1 in 531 women with the cesarean scar would have the Cesarean scar pregnancy and that nearly 4.2% of ectopic pregnancies are Cesarean scar pregnancy. Once the Cesarean scar pregnancy aborts or infiltrates into the muscular tissue, the patients usually suffer from series of dangerous complications, such as massive hemorrhage, uterine placenta implantation, uterine rupture, and they even need to receive a hysterectomy. Laparoscopy is today's method of choice for this type of ectopic pregnancy. Before starting laparoscopy, a hysteroscopy should be performed. During laparoscopic surgery first, you should dissect the peritoneum reflection, and the bladder should be pushed down to visualize the myometrial implantation site more clearly. You should dissect the gestation from the anterior uterine isthmus with electrocautery, the dark reddish tissue should be swiftly be removed with laparoscopic spoon forceps or harmonic scalpel. After complete resection of scar tissue, you should also repair the cesarean scar dehiscence with one layer of continuous laparoscopic suturing with 2–0 PDS or barbed suture. It is proved that traditional hysteroscopic-laparoscopic surgery was safe and efficient surgical procedures could be adopted as primary treatment modalities, the ideal management should be minimally invasive, with low morbidity and low cost. Reducing surgical time could lower the cost of surgery and the risk of complications. |
