Abstract
Only a few cases of laparoscopic uterine repair of cesarean scar dehiscence have been reported. We report a case of a 27-year-old gravida 1 para 1 patient who initially presented to us with cesarean scar pregnancy. She had a cesarean section because of premature rupture of membranes and breech presentation at 34 weeks of gestation. When she first consulted us, her chief complaint was amenorrhea. She was diagnosed with cesarean scar pregnancy and treated at another institution with dilation and curettage after uterine artery embolization. She consulted us again with concerns about the risks of subsequent pregnancy. Magnetic resonance imaging revealed thinning of the myometrium at the site of the previous cesarean scar, and a lack of endometrium was also suspected. To reconstruct uterine myometrium, we performed laparoscopic uterine scar repair with the patient's informed consent. Sonohysterography (SHG) during the procedure precisely showed the dehiscence of the previous uterine scar. We successfully identified the scar with the light source of the flexible hysteroscope. Post-operative SHG indicated that the thickness of the repaired myometrium was about 9 mm. We cleared the patient for subsequent pregnancy after 3 courses of Kaufmann therapy. It has been suggested that uterine scar dehiscence may increase the incidence of uterine rupture, placenta accreta, or recurrent uterine scar pregnancy, and whether or not uterine scar repair leads to a better prognosis in subsequent pregnancy is still under discussion. Further investigation is required.
