Laparoscopic Correction of Cesarean Scar Defects by Temporary Bilateral Uterine Artery Occlusion

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Background: The aim of our study was to evaluate the clinical efficacy of temporary bilateral uterine artery blockage for cesarean scar defects when combined with laparoscopy and hysteroscopy. Methods: We evaluated 126 patients who had one or more cesarean deliveries with abnormal uterine bleeding (12–20 days). All eligible women were informed of the potential complications, benefits, and alternatives, for each approach before they were assigned into one of two treatment groups. Group A received temporary bilateral uterine artery occlusion and vasopressin injection while Group B received vasopressin injection only. Results: Mean blood loss was 54.70 ± 13.01 mL and 190.82 ± 15.72 mL in Groups A and B (p < 0.001). By the final evaluation, the mean duration of menstruation had reduced to 6.92 ± 2.16 and 7.16 ± 2.25 days in Group A and Group B; these values were significantly different than the pre-operative values (p < 0.001 respectively). The mean thinnest residual myometrium was 5.39 ± 0.77 and 5.28 ± 1.25 mm in Group A and Group B, respectively. These values were thicker than pre-operative values (p < 0.001 respectively). The efficacy of anatomic correction was 96.88% (62/64) and 96.77% (60/62) (p > 0.999) in Groups A and B, respectively. Overall, 58 of the 64 (90.63%) patients in Group A and 57 of the 62 (91.94%) patients in Group B reported an improved menstrual cycle following surgery (p = 0.794). Conclusions: The combination of laparoscopy, hysteroscopy, temporary bilateral uterine artery occlusion, and the injection of vasopressin, offers an effective measure to reduce blood loss effectively.

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