A minimally invasive procedure to reduce menstrual bleeding.
A Caesarean scar defect, sometimes called a niche or isthmocele, can develop when the uterine scar from a previous Caesarean birth does not heal completely. For some people, this can cause abnormal bleeding, pelvic discomfort or fertility concerns.
Laparoscopic repair is a minimally invasive procedure that aims to repair the weakened area of the uterine scar. The goal is to restore the strength and shape of the uterine wall and, where appropriate, improve symptoms or support future fertility.
Your gynaecologist will assess your symptoms, medical history, imaging results and pregnancy plans to determine whether laparoscopic scar repair is appropriate for you.
Laparoscopic repair of a Caesarean scar defect is a keyhole surgical procedure used to repair a weakened or incomplete scar in the lower part of the uterus following a previous Caesarean birth.
Small instruments and a camera are inserted through small abdominal incisions, allowing your gynaecologist to access and examine the uterus. The scar defect can then be repaired using surgical techniques appropriate to your individual circumstances.
The procedure is designed to strengthen the affected area of the uterine wall while preserving the uterus.
Laparoscopic repair may be considered when a Caesarean scar defect is associated with symptoms or concerns that require surgical treatment.
You may experience symptoms if you:
Treatment options depend on the size and location of the defect, your symptoms and your future pregnancy plans. Options may include observation, medication, other procedures or surgical repair.
Laparoscopic repair may be considered when symptoms associated with a Caesarean scar defect continue or when repair is considered appropriate based on your individual circumstances.
Your gynaecologist will consider factors such as:
Important: Repair is not suitable for everyone with a Caesarean scar defect. Your doctor will discuss the potential benefits, risks and alternative treatment options before recommending surgery.
During laparoscopic repair, your gynaecologist uses a camera and specialised instruments inserted through small openings in the abdomen.
The scar defect is identified and the affected tissue may be removed or carefully prepared before the edges of the uterine wall are brought together and repaired with surgical sutures.
The aim is to restore the integrity of the uterine wall while preserving the uterus. The exact surgical technique will depend on the characteristics of your scar defect and your individual circumstances.
Before recommending laparoscopic scar repair, your gynaecologist will assess your symptoms, previous Caesarean history and imaging results to determine whether surgery is appropriate for you.
You may need an ultrasound or other investigations to assess the location and size of the defect and understand your individual anatomy.
Your doctor will also discuss:
During the Procedure
The procedure is performed under general anaesthetic, so you will be asleep during the operation. Small incisions are made in the abdomen to allow a laparoscope and surgical instruments to be introduced.
Your surgeon identifies the Caesarean scar defect, repairs the affected area and closes the small abdominal incisions once the procedure is complete.
What Can I Expect After Laparoscopic Scar Repair?
Many people can return home on the same day or the following day, depending on the extent of surgery and their recovery.
You may experience:
Your healthcare team will provide specific instructions about pain relief, wound care, activity and when you can return to your usual routine.
Recovery varies from person to person, so it’s important to follow the advice provided by your treating team.
Laparoscopic repair of a Caesarean scar defect may:
For some people, repair may improve symptoms or support future fertility goals, although individual outcomes can vary.
Important Considerations
Laparoscopic scar repair is not suitable for everyone and does not guarantee that symptoms or fertility concerns will completely resolve.
There are also potential risks associated with laparoscopic surgery, including infection, bleeding, injury to surrounding organs, blood clots and complications related to anaesthesia. Further surgery may occasionally be required. Your individual risks will depend on your health, previous surgery and the nature of the scar defect.
