EXPERIENCE OF TRANSVAGINAL EXTRAPERITONEAL APPROACH IN SURGICAL TREATMENT OF UTERINE SCAR LEAK AFTER CAESARIAN SECTION

Aim. A comparative analysis of mertoplasty results for treatment of uterine scar leak by different approaches.

Materials and methods. A retrospective analysis of hospital records of 51 patients was made, which were divided into three groups depending on the surgical approach used: group 1 – laparotomy access, group 2 – laparoscopic access, group 3 – transvaginal access. All patients had hysteroscopic and ultrasound signs of uterine scar leak after cesarean section (thickness of the myometrium in the scar area less than 4 mm, discontinuity of the scar). One month after the surgery, all the patients were examined by an obstetrician-gynecologist, all had a control ultrasound to assess the condition of the uterine scar. To assess the reliability of differences between groups, differences were considered significant at p <0.05.

Results. The mean age of the patients was 30.5±3.4 years. 76.4% of patients had one cesarean section, 23.5% of patients had had two caesarean sections. 11.7% of women had mentioned septic complications in the first 24 hours after cesarean section. The remaining 88.23% of patients had had no complications during postpartum period. Laparotomic access for excision of the uterine scar leak and metroplasty were used in 33.3% of patients, laparoscopic access – in 29.4% of cases, and vaginal access was used in 37.3% of patients. Pain severity after laparoscopy or transvaginal approach for metroplasty was moderate and allowed to use NSAIDs only, while pain severity after laparotomy required using of narcotic analgesics. There were no complications in patients under study. Based on the results of the follow-up examination and ultrasound examination, uterine scar was considered as satisfactory 1 month after the surgery in all patients, pregnancy planning was recommended 4-6 months after the surgery.

Conclusion. Results of metroplasty by vaginal access are comparable with those of laparotomic and laparoscopic access. This access has the following advantages: its use requires no expensive endoscopic equipment, small amount of intraoperative blood loss and low degree of invasiveness, moderate intensiveness of postoperative pain syndrome, short period of vocational rehabilitation.