Laparoscopic Isthmocele (Niche) Correction as prevention in patients with fertility desire

To report the technique of Laparoscopic Isthmocele (Niche) Correction and surgical outcomes.

The retrospective study included only patients with current or potential fertility desire who had laparoscopic surgery for an isthmocele at the Academic Hospital Cologne Weyertal between the beginning of 2014 and the end of 2020. A total of 28 patients were included. Sonographic follow-up of myometrial thickness was performed in 67% cases.

In 18% cases myometrial thickness was 5-7 mm, in 11% cases > 7-10 mm and in 39% cases > 10 mm. In the group with postoperative myometrium of 5-7 mm, two patients had preoperative residual myometrium of 2 mm, one patient of 2.5 mm and in one patient residual myometrium was not measurable (< 1 mm). In 11 patients, the postoperative myometrium was either greater than 10 mm and/or no isthmoceles were detectable. There was an increase in mean preoperative myometrial thickness from 2 mm to a mean myometrial thickness of 8.7 mm (myometrial thickness increase to 335%).

In this study, laparoscopic correction of the isthmocele resulted in an increase in myometrial thickness from 2 mm to 8.7 mm (average values). This represents an increase in myometrial thickness of 335%. According to the literature review performed and based on our own results, we recommend prophylactic isthmoceles correction in patients with fertility desire by means of laparoscopic procedure. Laparotomy should be performed only in special cases. Surgical hysteroscopy is not suitable for this purpose, but sufficient studies are still lacking.