Caesarean, if the scar is disturbing, a little intervention is enough

Who I am
Catherine Le Nevez
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Although necessary in various circumstances, the caesarean section also leaves a “beautiful” scar among the “memories”, which in some cases can cause some discomfort. “The pathologies of the caesarean section scar represent 'modern pathologies' since only thanks to technological progress and the considerable increase in caesarean sections have they been understood and studied. I am aware that, until a few years ago, the Del Paese was among the first nations in the world for the number of Caesarean sections. In scientific literature there has been talk of 'isthmocele' for about 10 years, so we can define it as a modern pathology ". The gynecologist explains everything to us Accardi, which visits of the city, Palermo, Caltanissetta and San Cataldo.

Dr. Accardi

    Doctor Accardi, what are the symptoms of the pathologies associated with the caesarean section scar?

    “The most typical symptom is what women refer to as the 'return of menstruation'. Post-menstrual and peri-ovulatory spotting (small blood loss, ed), post-menstrual and peri-ovulatory pelvic pain, collection of blood in the uterine cavity expelled intermittently after the menstrual cycle represent other more or less present signs. These main symptoms (pain and irregular blood loss) are often accompanied by secondary infertility which is often the reason why women go to the gynecologist ”.

    What is isthmocele and how is it formed?

    “It is an internal hernia of the uterine tissue that forms after the caesarean section. It is called isthmocele because it is created in that tract between the body and the cervix called the 'isthmus'. This area - which widens a lot during pregnancy - is the area that is incised and then sutured, during the caesarean section, to extract the baby. The incision of the uterine wall leads to the formation of a scar that can become more or less 'hypertrophic', causing the formation of a sac between the cervical canal and the internal uterine orifice. Menstrual blood can collect in this 'bag' causing pain and / or atypical blood loss. The scar itself can be a cause of infertility since it causes an obstruction to the transit of spermatozoa and / or can determine a local inflammatory state, further cause of atypical losses. Finally, over time, the scar itself can become covered with endometrial tissue so it actively responds to hormonal stimuli causing blood loss. To date, there are no real scientific explanations for why some scars are symptomatic and others are not ".

    How is the diagnosis made?

    "The diagnosis is based on the patient's clinical history, symptoms, ultrasound and hysteroscopic findings".

    Is it possible to heal the scar?

    “Scar surgery is purely hysteroscopic and consists in the removal of a part of the scar, to recreate the physiological anatomy of the uterus. The technique is called histmoplasty. Histmoplasty is reserved for all those patients who present troublesome symptoms attributable to the post-caesarean scar or for those women with secondary infertility in which all other known causes of infertility have been excluded. It is preferable to perform this technique in the operating room with special miniaturized instruments, since, if done under sedation, it is not painful. The diagnosis with 'diagnostic hysteroscopy' is performed in the outpatient clinic, but the treatment is surgical and takes place in the operating room. More specifically, histmoplasty does not aim to repair the collapse of the wall, which cannot be reconstructed hysteroscopically (therefore without a surgical cut on the abdomen), but to 'clean up' the area from scarring and inflammatory phenomena that occur. progressively. Sometimes it is also necessary to trim the scars that obstruct the uterine cavity in that area ".

    Can you list the benefits and risks of hysteroscopy?

    “The main advantage of the hysteroscopic technique is that of being able to avoid traditional or even laparoscopic surgery for the removal of the caesarean scar. The surgery takes just a few minutes and recovery is almost immediate. Symptoms are resolved in over 80% of cases. The risks are those related to operative hysteroscopy and anesthetic sedation. For clarity, the complication rate in operative hysteroscopy is about 2% ".

    What are the most common applications of this method?

    “Hysteroscopy is a minimally invasive outpatient endoscopic technique or also performed in the operating room that allows the diagnosis and treatment of the most common gynecological pathologies. Today it is essential for the removal of polyps, submucosal fibroids (or myomas), for the treatment of uterine malformations and in particular for the uterus septum, for the diagnosis of endometrial cancer and for the diagnosis of infertility ".

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