Efficacy, Safety and Outcomes of the Laparoscopic Management of Cesarean Scar Ectopic Pregnancy as a Single Therapeutic Approach: A Case Series
A standardized consensus for the management of cesarean scar pregnancy (CSP) is lacking. The study objective is to evaluate the efficacy, safety and outcomes of the laparoscopic management of CSP as a single therapeutic surgical approach without being preceded by vascular pretreatment or vasoconstri...
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| Format: | Article |
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MDPI AG
2023-12-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/24/7673 |
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| author | Georges Salem Wehbe Inesse Ait Amara Michelle Nisolle Dominique A. Badr Marie Timmermans Stavros Karampelas |
| author_facet | Georges Salem Wehbe Inesse Ait Amara Michelle Nisolle Dominique A. Badr Marie Timmermans Stavros Karampelas |
| author_sort | Georges Salem Wehbe |
| collection | DOAJ |
| description | A standardized consensus for the management of cesarean scar pregnancy (CSP) is lacking. The study objective is to evaluate the efficacy, safety and outcomes of the laparoscopic management of CSP as a single therapeutic surgical approach without being preceded by vascular pretreatment or vasoconstrictors injection. This is a retrospective bi-centric study, a case series. Eight patients with a future desire to conceive underwent the laparoscopic treatment of unruptured CSPs. Surgery consisted of “en bloc” excision of the deficient uterine scar with the adherent tissue of conception, followed by immediate uterine repair. The data collected for each patient was age, gestity, parity, number of previous c-sections, pre-pregnancy isthmocele-related symptoms, gestational age, fetal cardiac activity, initial β-human chorionic gonadotropin levels, intra-operative blood loss, blood transfusion, operative time and the postoperative complications, evaluated according to Clavien–Dindo classification. The CSP was successfully removed in all patients by laparoscopy. The surgical outcomes were favorable. All patients with histories of isthmocele-related symptoms reported postoperative resolution of symptoms. The median residual myometrium thickness increased significantly from 1.2 mm pre-operatively to 8 mm 3 to 6 months after surgery. The laparoscopic management seems to be an appropriate treatment of CSP when performed by skilled laparoscopic surgeons. It can be safely proposed as a single surgical therapeutic approach. Larger series and further prospective studies are needed to confirm this observation and to affirm the long-term gynecological and obstetrical outcomes of this management. |
| first_indexed | 2024-03-08T20:38:56Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-08T20:38:56Z |
| publishDate | 2023-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-7b3fe998394c402393a6d144ac8d073c2023-12-22T14:17:24ZengMDPI AGJournal of Clinical Medicine2077-03832023-12-011224767310.3390/jcm12247673Efficacy, Safety and Outcomes of the Laparoscopic Management of Cesarean Scar Ectopic Pregnancy as a Single Therapeutic Approach: A Case SeriesGeorges Salem Wehbe0Inesse Ait Amara1Michelle Nisolle2Dominique A. Badr3Marie Timmermans4Stavros Karampelas5Department of Obstetrics and Gynecology, University Hospital Brugmann, Free University of Brussels, 1020 Brussels, BelgiumDepartment of Obstetrics and Gynecology, University Hospital Brugmann, Free University of Brussels, 1020 Brussels, BelgiumDepartment of Obstetrics and Gynecology, Hospital the Citadelle, University of Liege, 4000 Liege, BelgiumDepartment of Obstetrics and Gynecology, University Hospital Brugmann, Free University of Brussels, 1020 Brussels, BelgiumDepartment of Obstetrics and Gynecology, Hospital the Citadelle, University of Liege, 4000 Liege, BelgiumDepartment of Obstetrics and Gynecology, University Hospital Brugmann, Free University of Brussels, 1020 Brussels, BelgiumA standardized consensus for the management of cesarean scar pregnancy (CSP) is lacking. The study objective is to evaluate the efficacy, safety and outcomes of the laparoscopic management of CSP as a single therapeutic surgical approach without being preceded by vascular pretreatment or vasoconstrictors injection. This is a retrospective bi-centric study, a case series. Eight patients with a future desire to conceive underwent the laparoscopic treatment of unruptured CSPs. Surgery consisted of “en bloc” excision of the deficient uterine scar with the adherent tissue of conception, followed by immediate uterine repair. The data collected for each patient was age, gestity, parity, number of previous c-sections, pre-pregnancy isthmocele-related symptoms, gestational age, fetal cardiac activity, initial β-human chorionic gonadotropin levels, intra-operative blood loss, blood transfusion, operative time and the postoperative complications, evaluated according to Clavien–Dindo classification. The CSP was successfully removed in all patients by laparoscopy. The surgical outcomes were favorable. All patients with histories of isthmocele-related symptoms reported postoperative resolution of symptoms. The median residual myometrium thickness increased significantly from 1.2 mm pre-operatively to 8 mm 3 to 6 months after surgery. The laparoscopic management seems to be an appropriate treatment of CSP when performed by skilled laparoscopic surgeons. It can be safely proposed as a single surgical therapeutic approach. Larger series and further prospective studies are needed to confirm this observation and to affirm the long-term gynecological and obstetrical outcomes of this management.https://www.mdpi.com/2077-0383/12/24/7673cesarean scar pregnancylaparoscopic cesarean scar pregnancy excisionisthmoceleresidual myometrium thickness |
| spellingShingle | Georges Salem Wehbe Inesse Ait Amara Michelle Nisolle Dominique A. Badr Marie Timmermans Stavros Karampelas Efficacy, Safety and Outcomes of the Laparoscopic Management of Cesarean Scar Ectopic Pregnancy as a Single Therapeutic Approach: A Case Series Journal of Clinical Medicine cesarean scar pregnancy laparoscopic cesarean scar pregnancy excision isthmocele residual myometrium thickness |
| title | Efficacy, Safety and Outcomes of the Laparoscopic Management of Cesarean Scar Ectopic Pregnancy as a Single Therapeutic Approach: A Case Series |
| title_full | Efficacy, Safety and Outcomes of the Laparoscopic Management of Cesarean Scar Ectopic Pregnancy as a Single Therapeutic Approach: A Case Series |
| title_fullStr | Efficacy, Safety and Outcomes of the Laparoscopic Management of Cesarean Scar Ectopic Pregnancy as a Single Therapeutic Approach: A Case Series |
| title_full_unstemmed | Efficacy, Safety and Outcomes of the Laparoscopic Management of Cesarean Scar Ectopic Pregnancy as a Single Therapeutic Approach: A Case Series |
| title_short | Efficacy, Safety and Outcomes of the Laparoscopic Management of Cesarean Scar Ectopic Pregnancy as a Single Therapeutic Approach: A Case Series |
| title_sort | efficacy safety and outcomes of the laparoscopic management of cesarean scar ectopic pregnancy as a single therapeutic approach a case series |
| topic | cesarean scar pregnancy laparoscopic cesarean scar pregnancy excision isthmocele residual myometrium thickness |
| url | https://www.mdpi.com/2077-0383/12/24/7673 |
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