Combined hysteroscopic and laparoscopic management of an isthmocele: about a case report

Isthmocele, a cesarean scar defect, is a common complication of cesarean delivery that can cause postmenstrual spotting, pelvic pain, and infertility. Its management requires accurate diagnosis and tailored surgical approaches, especially in women desiring future fertility.

A 29-year-old woman with a history of cesarean section presented with pelvic pain, metrorrhagia, and secondary infertility. Ultrasound and hysteroscopy confirmed an isthmocele with a residual myometrial thickness of 2.2 mm. She underwent a combined laparoscopic and hysteroscopic repair. The defect was excised and reconstructed using two layers of size 0 absorbable sutures. Postoperative recovery was uneventful, and follow-up hysteroscopy at 8 weeks showed complete resolution of the defect.

Isthmocele symptoms arise from menstrual blood retention in the defect. Deeper defects benefit from laparoscopic repair, which restores uterine wall integrity, particularly for fertility preservation. The combined approach enhances defect localization and repair precision, as demonstrated in this case.

This case underscores the effectiveness of a combined laparoscopic and hysteroscopic approach in managing isthmocele, achieving symptom resolution and uterine integrity restoration. Individualized management and long-term follow-up are essential for optimizing outcomes.