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

## TL;DR

A 29-year-old woman with a cesarean scar defect was successfully treated using a combined laparoscopic and hysteroscopic approach, resolving symptoms and restoring uterine integrity.

## Contribution

This case report demonstrates the effectiveness of a combined surgical approach for isthmocele repair in preserving fertility.

## Key findings

- The combined laparoscopic and hysteroscopic repair led to complete resolution of the isthmocele defect.
- The approach allows for precise localization and reconstruction of the defect, aiding in fertility preservation.
- Postoperative follow-up confirmed successful restoration of uterine wall integrity.

## Abstract

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.

•A 29-year-old woman with pelvic pain, metrorrhagia, and infertility was diagnosed with isthmocele after a cesarean section.•The patient underwent a successful combined laparoscopic and hysteroscopic repair, with complete resolution of the defect at 8 weeks follow-up.•The combined approach offers precise defect localization and effective repair, especially in cases aiming for fertility preservation.

A 29-year-old woman with pelvic pain, metrorrhagia, and infertility was diagnosed with isthmocele after a cesarean section.

The patient underwent a successful combined laparoscopic and hysteroscopic repair, with complete resolution of the defect at 8 weeks follow-up.

The combined approach offers precise defect localization and effective repair, especially in cases aiming for fertility preservation.