Work

Cesarean scar niche repair with the rendez-vous technique: comparison of pre- and postoperative symptoms, sonographic findings and quality of life

Year: 2025

Type: article

Abstract: OBJECTIVE: Niche is defined as a defect at the level of a previous uterine cesarean incision, potentially causing gynecological and obstetric problems. Surgical treatment is indicated if symptoms arise, but the correction of a niche is not standardized. In the so-called rendez-vous technique, the defect is visualized by hysteroscopy and identified by transillumination through the abdominal cavity, providing an optimal basis for laparoscopic resection and repair. The aim of this study was to investigate this surgical approach regarding its impact on niche-related symptoms, quality of life and residual myometrial thickness measured with ultrasound. STUDY DESIGN: This observational single-center cohort study included patients with symptomatic cesarean scar defects (≥2 mm depth on transvaginal sonography) operated between 2017 and 2020 using the rendez-vous technique. At least 6 months post-surgery, patients underwent follow-up transvaginal sonography to examine the scar area and completed a questionnaire related to symptoms and quality of life. RESULTS: In total, 18 consecutive patients were included. Abnormal uterine bleeding, dysmenorrhea, dyspareunia, and pelvic pain were significantly reduced after 6 months compared with baseline. The median thickness of the residual myometrium increased significantly from 1.45 mm (0.00-7.40 mm) before surgery to 6.62 mm (1.57-12.40 mm) after surgery. Among the 12 women with secondary infertility, 4 (33.3 %) became pregnant and delivered term babies. Subjectively, quality of life increased for all symptoms while women with secondary infertility showed heterogenous satisfaction. CONCLUSIONS: Laparoscopic surgical repair of a symptomatic cesarean scar niche by the rendez-vous technique increases residual myometrial thickness 6 months after surgery, reduces niche-related symptoms and secondary infertility.

Source: European Journal of Obstetrics & Gynecology and Reproductive Biology

DOI: 10.1016/j.ejogrb.2025.114566