Abstract

Objective: To evaluate gynecological and obstetrical outcomes, as well as remaining myometrial thickness, after laparoscopic repair of a cesarean scar. Design: Observational study and prospective evaluation of the remaining myometrium before and after repair. Setting: Academic department in a university hospital. Patient(s): A series of 38 symptomatic women with cesarean scar defects and remaining myometrial thickness of less than 3 mm, according to magnetic resonance imaging. Intervention(s): Laparoscopic repair of the defect. Main Outcomes Measure(s): Increase in myometrial thickness at the site of cesarean section, gynecological and obstetrical outcomes, and histological analysis of the defect after excision. Result(s): The mean thickness of the myometrium increased significantly from 1.43 +/- 0.7 mm before surgery to 9.62 +/- 1.8 mm after surgery. All but three patients were free of symptoms. Among the 18 women with infertility, eight (44%) became pregnant and delivered healthy babies by cesarean section at 38-39 weeks of gestation. Histological analysis, performed in all 38 cases, revealed the presence of endometriosis in eight women (21.1%). Muscle fiber density was significantly lower compared with adjacent myometrium. Conclusion(s): In symptomatic women with residual myometrial thickness of less than 3 mm who wish to conceive, laparoscopic repair could be considered an appropriate approach. ((C) 2016 by American Society for Reproductive Medicine.)