A New Problem Arising After the Cesarean, Cesarean Scar Defect (Isthmocele) a Case Report

Cesarean rates continue to increase all over the world.Obstetric complications showed a similar increase with increasing cesarean section rate.With the many obstetric complications of increased cesarean rates, isthmocele terminology as also defined cesarean scar defecthas begun to used in the current literature. Isthmocele is a defect that appears like a dome or pocket that is localized on the old cesarean scar. The global frequency is observed between 6.2% and 36%, with an average rate of 21.1% [1]. This defect including mucus, old blood, debris and inflammatory cells may be responsible for clinical symptoms such as premenstrual bleeding, dysmenorrhea, dyspareunia and infertility. The most reported symptoms about isthmocele are postmenstrual spotting and infertility. The main risk factors are uterine incision closure techniques, suture materials, transverse lower uterine incision and wound healing [2]. The main reason for the increase in all these risk factors is increased cesarean rates. According to OECD data by 2015, vaginal birth rates are 72.4% on average, whereas in Turkey this rate is 47%. Several techniques have been described for isthmocele repair. These are combined laparoscopic-vaginal and complete vaginal approaches. Laparoscopic excision of the fibrotic tissue at the edges of the caesarean scar or hysteroscopic resection of the fibrotic tissue. The choice of treatment approach should be based on whether the patient has a complaint, the thickness of the myometrium over the cesarean scar defect and the size of the defect [3]. Today, there is no comprehensive scientific work to provide sufficient information about the ideal approach. In this case report, we described the laparoscopic approach to a patient with abnormal uterine bleeding diagnosed with isthmocele in the light of current literature.