Retrospective analysis of hysteroscopic diverticulum endometrialablation combined with laparoscopic scar defect reinforcecement in the treatment of caesarean section scar diverticulum

Objective To explore a more effective surgical approach to treat cesarean scar diverticulum. Methods A total of 60 patients who were diagnosed with cesarean scar diverticulum in Xuzhou Maternal and Child Health Care Hospital were enrolled and their clinical data were retrospectively analyzed. All patients underwent hysteroscopic diverticulum endometrial ablation combined with laparoscopic scar defect reinforcement. The patients were followed up one month after operation, and their menstrual period was followed up 3, 6 and 12 months after operation. The thickness of the thinnest muscle layer at the scar of the lower uterine segment and the volume of the cesarean scar diverticulum were measured by ultrasound. The number of intrauterine pregnancy cases was followed up 24 months after operation. Results There were no postoperative complications in all the patients; 51 cases (85%) were cured, 9 cases (15%) were ineffective, and 3 cases (5.0%) recurred. The median menstrual period was 8.1, 8.2 and 8.5 days 3, 6 and 12 months after operation respectively, which was significantly shorter than 13 days before operation (P<0.05). The median volume of the scar diverticulum of cesarean section 3, 6 and 12 months after operation was 0.42, 0.37 and 0.54 cm³ respectively, which was significantly less than that before treatment (P<0.05). The median thickness from the bottom of the cesarean scar diverticulum to the thinnest muscle layer of the serosa layer 3, 6 and 12 months after operation was 0.25, 0.25 and 0.24 cm respectively, which was greater than that before treatment (P<0.05). Conclusions A combined use of hysteroscopic diverticulum endometrial ablation and laparoscopic scar defect reinforcement in the treatment of cesarean scar diverticulum can not only shorten the menstrual period of patients with diverticulum, but also effectively repair the anatomical structure of the lower uterine scar, without destroying the continuity of muscle tissue in the diverticulum, increasing the thickness of muscle layer and reducing the risk of uterine rupture in pregnancy again.