The Surgical Outcomes Of The Transvaginal Surgery Of Cesarean Section Scar Diverticulum And The Relevant Factors Of Recurrence Of Diverticulum After Surgery

BackgroundCesarean scar diverticulum is defined as a healing defect due to various factors following cesarean section which is a concavity or a gap in the myometrium of the anterior lower uterine segment at the site of the previous caesarean section. The accumulation of the menstual blood or the desynchronic shedding of endometrium in the diverticulum and uterine endometrium result in postmenstrual spotting, intermenstrual bleeding, lower abdominal pain and infertility.This seriously affect the quality of the patients’life.The relevant therapies includes conservative medication, hysteroscopic surgery,laparoscopic surgery and transvaginal surgery.In clinical practice,there isn’t an unified criterion on the choose of the surgical method or the evaluation of the therapeutic effect. So it is important to keep gaining insight into this disease.ObjetiveStudy the surgical outcomes of the transvaginal surgery of cesarean section scar diverticulum and the relevant factors of recurrence of diverticulum after surgery.MethodWe collected the clinical data of the 156 patients who made a definite diagnosis of CSD and underwent transvaginal surgery in the First Affiliated Hospital of Sun yat-sen University from January lst,2010 to December 31 st,2014.We analysed thematerial of the previous cesarean section,main symtoms,the onset of symptoms,perioperative period data,symptoms improvment,pregnancy outcomes and incision healing condition after surgery retrospectively.SPSS 22 was used for statistical analysis.ResultThe average age of the patients when they underwent caesarean section was 27.6±4.0 years.Times of caesarean section is once in 92 (59%) patients,twice in 62 (39.7%) patients and thrice in 2(1.3%)patients.The primary three indications for the caesarean section was scarred uterus in 62 (39.7%) patients,social factors in 30 (19.2%) patients and prolonged latent phase in 29 (18.6%) patients.As to the starting time of the symptoms,it is the return of menses in 114 (73.1%) patients, after a period time of normal menstruation in 35(22.4%) patients,after induced abortion in 5 (3.2%) patients,after drug abortion in 1(0.7%) patient and after induced labour in 1(0.7%) patient.The cilinical symtom was postmenstrual spotting only in 123 (78.8%) patients,postmenstrual spotting with lower abdominal pain in 14 (9.0%) patients,postmenstrual spotting with infertility in 8 (5.1%) patients,intermenstrual bleeding only in 9 (5.8%) patients and intermenstrual bleeding with infertility in 2 (1.3%) patients.The average age of the patients when underwent transvaginal surgery was 32.3±4.3 years.Average operation time estimated blood loss insurgery and hospital stay was 50.74±20.8 minutes,39.6±22.1mL,6.8±2.5 days.The patients’ symtoms was completely improved in 61 (39.1%) patients,partially improved in 55 (35.3%) patients and unimproved in 40 (25.6%) patients.17 of the 44 patients who desired future fertility become pregnant 3 months to 2.6 years after the surgery.After regression analysis, the time interval of the last cesarean section to surgery more than 5 years(OR 2.2,[95% CI 1.0-5.0]; P=0.048) and the hemoglobin less than 110 g/L after surgery (OR 3.5,[95% CI 1.3-9.6]; P=0.016) are the risk factors of recurrence of diverticulum after transvaginal surgery.ConclusionThe most common symptoms in the CSD patinets were postmenstrual spotting and intermenstrual bleeding,which mostly emerge when the menstruation return aftercaesarean section.The transvaginal surgery is a safe and effevtive therapeutic approach for CSD patients in whom there are surgical indication.Time interval of the last cesarean section to surgery more than 5 years and the hemoglobin less than 110 g/L after sugery are the risk factors of recurrence of diverticulum after transvaginal surgery.