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

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.