What is Isthmocele Surgery? Methods, Benefits and Healing Process

Isthmocele is a wound healing defect that occurs in the lower part of the uterus (uterine isthmus) after a cesarean delivery. This "pocket"-shaped defect, which occurs as a result of the incision area not healing properly after a cesarean, can lead to abnormal bleeding in the uterus, chronic pelvic pain and infertility problems. Isthmocele surgery is the surgical correction of this problem. It is performed using minimally invasive methods, especially laparoscopic and hysteroscopic techniques. Surgery repairs this scar tissue in the uterus and allows the uterine wall to return to its normal shape.

 

What is an isthmocele?

An isthmocele is a defect that occurs in the lower part of the uterus after a cesarean delivery, resulting from impaired wound healing. When the cesarean incision line does not heal properly, a pocket-like space can form inside the uterus. This occurs especially in the lower part of the uterus (isthmus region). Isthmocele can cause fluid or blood accumulation in the uterus, causing prolonged bleeding after menstruation and other problems.

Basic Features of Isthmocele:

• Occurs After Cesarean Section: It develops as a result of improper wound healing in women who have had a cesarean section.
• Defect in the Uterine Wall: A weakness or pocket-shaped scar tissue forms in the uterine wall.
• Can Cause Symptoms: It can cause symptoms such as abnormal bleeding, pelvic pain, and infertility.

Isthmocele is especially common in women who have complaints of prolonged bleeding and pain after a cesarean section.

Why Does Isthmocele Occur?

Isthmocele usually occurs due to tissues that do not heal properly after a cesarean section. This wound healing problem in the uterine wall can be associated with the following factors.

Factors Contributing to Isthmocele Formation:

• Number of Cesarean Sections: The risk of isthmocele development increases in women who have had more than one cesarean section.
• Early Uterine Contractions: Early uterine contractions after a cesarean section can prevent the stitches from healing properly.
• Surgical Techniques: The techniques used by the surgeon play an important role in the proper healing of the incision line.
• Intrauterine Infections: Infections after a cesarean section can disrupt wound healing and cause isthmoceles can pave the way for its formation.

These factors are the main factors in the development of isthmocele and constitute an important part of the complications that occur after cesarean section.

What are the Symptoms of Isthmocele?

Istmocele can occur with different symptoms in different women. The most common complaints include abnormal menstrual bleeding and chronic pelvic pain.

Common Symptoms of Isthmocele:

• Abnormal Bleeding: Long-lasting spotting and bleeding after menstruation are among the most common symptoms.
• Pelvic Pain: Pain may occur in the pelvic area, especially during sexual intercourse or during menstrual periods.
• Infertility: Isthmocele can cause fluid accumulation in the uterus, making it difficult to conceive.
• Menstrual Irregularities: Long-lasting menstrual periods or heavier bleeding than normal can be seen.

These symptoms may be noticed during the recovery period after a cesarean section, or they may appear years later.

How is Isthmocele Diagnosed?

Istmocele is diagnosed using clinical symptoms and various imaging methods. It is usually investigated in women after cesarean section who have long-term bleeding complaints.

Isthmocele Diagnosis Methods:

• Ultrasound: The isthmocele defect and fluid accumulation in the uterus can be detected with vaginal ultrasound.
• Hysteroscopy: By placing a hysteroscope inside the uterus, the inside of the uterus is directly visualized and isthmocele can be diagnosed definitively.
• MRI (Magnetic Resonance Imaging): It can be used to evaluate structural disorders in the uterus in detail.

These imaging methods clearly reveal the size and effects of isthmocele.

Isthmocele Treatment Methods

Isthmocele treatment is determined by the patient's symptoms and the size of the isthmocele. Some mildWhile some cases can be managed with monitoring, more serious cases require surgical intervention.

Isthmocele Treatment Options:

• Monitoring: Asymptomatic and small isthmocele cases can be monitored. Regular check-ups are performed.
• Laparoscopic Surgery: With the laparoscopic method, the isthmocele can be repaired by approaching from outside the uterus.
• Hysteroscopic Surgery: With the hysteroscopic method, the defect can be corrected by entering from inside the uterus.

Treatment methods are determined by the doctor according to the severity of the patient's symptoms and the condition of the isthmocele.

How is Laparoscopic Isthmocele Surgery Performed?

Laparoscopic isthmocele surgery is a minimally invasive procedure performed through small incisions in the abdominal area. With this surgical method, the isthmocele defect in the uterus is corrected.

Laparoscopic Surgery Stages:

1. Anesthesia: The patient is taken into surgery under general anesthesia.
2. Making Small Incisions: 2-3 small incisions are made in the abdominal area.
3. Placement of the Laparoscope: A camera called a laparoscope is placed and the inside of the uterus is viewed in detail.
4. Repair of the isthmocele: The defect in the uterine wall is repaired or reconstructed with stitches.
5. Stitches and Closure: The incisions are closed with stitches and the surgery is completed.

This method is a minimally invasive intervention performed from outside the uterus and the recovery period is quite short.

How is Hysteroscopic Isthmocele Surgery Performed?

Hysteroscopic isthmocele surgery is a minimally invasive procedure performed vaginally. The inside of the uterus is visualized in detail using a hysteroscope and the defect is treated.

Hysteroscopic Surgery Stages:

1. Anesthesia: It is performed under general or local anesthesia.
2. Hysteroscope Placement: The hysteroscope is placed vaginally into the uterus.
3. Isthmocele Repair: The scar tissue in the uterus is corrected or the excess is cleaned.
4. Final Check and Exit: The inside of the uterus is checked and the procedure is completed.

This method is quite effective for solving the isthmocele problem with rapid recovery and minimal trauma.

Benefits of Isthmocele Surgery

Isthmocele surgery provides relief from symptoms experienced by patients and improves uterine health. This surgery offers significant advantages, especially for patients with chronic pain and abnormal bleeding.

Main Benefits of the Surgery:

• Pain Reduction: Pelvic pain and pain experienced during sexual intercourse are greatly reduced.
• Stopping Abnormal Bleeding: Long-lasting postmenstrual spotting or bleeding improves after surgery.
• Increased Chance of Pregnancy: Since the uterus returns to its normal shape after surgery, the chance of pregnancy may increase.

These benefits increase the quality of life of patients and provide a significant advantage for women planning a pregnancy.

Post-Operative Recovery Process

The recovery process after isthmocele surgery is usually rapid. Especially when laparoscopic and hysteroscopic methods are used, patients can return to their normal activities in a short time.

Things to Consider During the Recovery Process:

• Rest: It is important to rest for the first few days. Light activities can be done, but heavy lifting should be avoided.
• Pain Management: There may be mild pain after surgery, painkillers can be used.
• Sexual Intercourse: It is recommended to avoid sexual intercourse for 4-6 weeks after surgery.
• Physical Activity: Heavy physical activity should be avoided for a few weeks after surgery.

Full recovery is usually completed within 4-6 weeks.

Isthmocele Surgery Risks

Isthmocele surgery is generally a safe procedure since it is performed using minimally invasive surgical methods. However, as with any surgical intervention, it carries some risks.

Possible Risks:

• Infection: Although the risk of infection after a surgical procedure is low, it is a risk as with any surgery.
• Bleeding: Bleeding may occur during or after surgery, but these complications are rare.
• Wound Healing Problems: Rarely, healing problems may develop in the surgical area.

These risks are rare and the risk of complications is usually very low in procedures performed by experienced surgeons.

Isthmocele and Pregnancy

Isthmocele can negatively affect the chance of pregnancy if it is not treated. After surgery, women can increase their chances of pregnancy and have a healthy pregnancy.

Post-Operative Pregnancy Chance:

• Increased Chance of Pregnancy: The shape of the uterus after surgery The chance of pregnancy increases with the correction.
• Reduced Risk of Miscarriage: The risk of miscarriage decreases as the intrauterine structure returns to normal.

It is important for women planning a pregnancy after the surgery to follow the processes under the supervision of a doctor.

Frequently Asked Questions (FAQ)

1. Is isthmocele surgery painful?

Since general anesthesia is applied during the surgery, no pain is felt. There may be mild pain after the surgery, but this pain can usually be controlled with painkillers.

2. How long does it take to recover after isthmocele surgery?

Full recovery usually takes 4-6 weeks. However, light activities can be done within a few days.

3. Can I have a cesarean section again after surgery?

Yes, you can have a cesarean section again after surgery. However, it is important to discuss this with your doctor beforehand.

4. Is pregnancy possible after isthmocele surgery?

Yes, the chance of pregnancy increases when the uterine structure improves after surgery. You should discuss your pregnancy plans with your doctor.

5. What are the risks of surgery?

Isthmocele surgery is generally safe, but it carries rare risks such as infection, bleeding and wound healing problems.

6. Which method should I have surgery with, laparoscopic or hysteroscopic?

This decision will be made by the doctor depending on the size and location of the isthmocele. Both methods are minimally invasive and provide rapid recovery.