SEQUELA OF CESAREAN SECTION DELIVERY; ISTMOCELE

Öz

This study aims to reveal the current literature about the methods in the diagnosis and treatment of isthmocele. A total of 72 case reports and clinical studies using the key words “isthmocele”, “niche” and “uterine scar defect” which were published in English language between the years 2008 and 2020, were searched from the Pubmed database. Amongst these publications, 32 clinical studies and case reports that were only related to the diagnosis and treatment of isthmocele and whose full texts are available, were included in the study. Forty publications were excluded from the study due to not being a related to isthmocele, unavailability of full text, and publication in other languages. Symptoms, complication, treatment methods and their success were evaluated. A total of 1021 cases described in 32 clinical trials and case reports were evaluated of the cases. Hysteroscopy was perfomed in 385 cases, laparoscopy was performed in 151 cases, hysteroscopy combined with laparoscopy was performed in 36 cases, vaginal repair was performed in 287 cases, vaginal repair combined with laparoscopy was performed in 37 cases, and laparotomy was performed in five cases. Medical treatment was applied in 120 cases. All patients who had surgery were symptomatic and complications were reported only in 4 patients who underwent surgery. Isthmocele can be easily diagnosed with ultrasonography and sonohysterography, which are frequently used in daily practice. Isthmocele should be kept in mind especially in patients with retroflexed uterus and old cesarean history who have abnormal uterine bleeding, secondary infertility, and pelvic pain. Surgical treatment yields successful results especially in symptomatic patients as it.

Anahtar Kelimeler

• Istmocele
• Laparoscopy
• Hysteroscopy
• Cesarean scar defect

SEZARYEN DOĞUM SEKELİ; İSTMOSEL

Öz

Bu çalışma, istmoselin tanı ve tedavisinde kullanılan yöntemler hakkında güncel literatürü ortaya çıkarmayı amaçlamaktadır. Pubmed veri tabanından 2008 - 2020 yılları arasında istmosel, niş, uterus skar defekti tanılı, İngilizce yayın dili olan, toplam 72 olgu sunumu ve klinik çalışma incelendi. Bu yayınlardan tam metnine ulaşılabilinir ve sadece isthmosel tanı ve tedavisi ile ilgili olan 32 klinik çalışma ve olgu raporu çalışmaya alındı. Kırk çalışma ise istmosel ile ilişkili yayın olmama, tam makale metnine ulaşılamaması, başka bir dilde yayımlanması nedeni ile çalışma dışı bırakıldı. Tedavi yöntemleri, başarıları, hasta semptomları ve komplikasyonlar değerlendirildi. Literatürdeki 32 klinik çalışma ve olgu raporunda tanımlanan 1021 olgu incelendi. Bu olguların 385’ine histeroskopi, 151’ine laparoskopi, 36’sına histeroskopi eşliğinde laparoskopi, 287’sine vaginal tamir, 37’sine laparoskopi eşliğinde vaginal tamir, 5’ ine laparotomi, 120’sine ise medikal tedavi uygulandığı belirlendi. Cerrahi uygulananların tamamı semptomatik hastalar olup sadece 4 hastada komplikasyon bildirilmiştir. İstmosel tanısı, özellikle klinikte çok sık kullanılan ultrasonografi ve sonohisterografi ile rahatlıkla konulabilir. Özellikle retroflex uteruslu, eski sezaryen öyküsü olan hastalarda, anormal uterin kanama, sekonder infertilite ve pelvik ağrı şikayetleri varlığında istmosel akılda tutulmalıdır. Cerrahi tedavi, özellikle semptomatik hastalarda oldukça iyi sonuçlar vermektedir

Anahtar Kelimeler

• İstmosel
• Laparoskopi
• Histeroskopi
• Sezaryen skar defekti

Kaynakça

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