Isthmoplasty: Surgical Techniques and Review of Literature

The present review aims to analyze the current data available on the different endoscopic surgical techniques described for Isthmocele treatment. A semantic review of literature was made of all english language publications on databases Pubmed and Google Scholar following a Mesh and key word searching. The studies were finally selected by one author according to the aim of this review. The isthmocele, defined as a defect of the anterior wall of the uterine cervical canal at the site of a previous cesarean section scar, is a prevalent condition in women submitted to gynecological endoscopic procedures. Epidemiological studies report a 1.9% of cesarean scar defects, rising in the last decades, and it is clear that the repair carrie benefits in terms of symptom control and sub-fertility. The minimally invasive approach is the gold standard due the inherent benefits in quality and magnification of image, less postoperative pain, hospital stay and minor complications rate. It can be treated either by laparoscopy or hysteroscopy according to the presentation of the disease and the preference of the surgical team, since both have the same efficacy in symptoms improvement (59% to 90%). Laparoscopy is usually indicated when overlying myometrial mantle is less than 3 mm, and allows an increase in postoperative myometrial streght. Different surgical techniques have been described and supposedly, there is no significant difference among them. Large analytical prospective experimental studies are required to confirm the results of this data and to investigate as to whether there is a better laparoscopic technique.