Comparison of the Efficacy of Two Laparoscopic Surgical Procedures Combined with Hysteroscopic Incision in the Treatment of Cesarean Scar Diverticulum

Abstract

Objective: To investigate the efficacy of two different surgical procedures in combined hysteroscopic and laparoscopic surgery—the “folding suture method” and the “muscle flap filling suture method"—in the treatment of cesarean scar diverticulum (CSD). Methods: The clinical data of 24 patients with CSD who underwent surgery in the Peking University First Hospital from August 2016 to December 2018 were retrospectively analyzed. Results: There was no difference in age, vaginal bleeding time, thickness of the lower uterine segment, operative time and intraoperative bleeding between the two groups. At three months after the operation, the patients of the folding suture and muscle flap groups had an average menstrual period of 6.9 ± 1.8 days and 7.5 ± 3.0 days, respectively, which was 5.8 ± 4.2 days and 4.4 ± 3.8 days, respectively, shorter than that before the operation, as well as a lower segment thickness of the uterus of 6.7 ± 1.8 mm and 6.3 ± 1.7 mm, respectively. Among the patients in the folding suture and muscle flap groups, 8 and 6 cases were cured, and 3 and 6 cases were improved, respectively, resulting in an effective rate of 100%. There was no significant difference in any indicator between the two groups. Conclusion: As two new surgical methods that preserve uterine integrity, the laparoscopic "muscle flap filling suture method" and “folding suture method” combined with hysteroscopic incision are safe and effective treatments for repairing CSD.

Keywords

• cesarean scar diverticulum
• treatment
• combined hysteroscopic and laparoscopic surgery
• folding suture method
• muscle flap filling suture method
• uterine segment