Isthmocele

Treatment of the isthmocele should be agreed upon based on a number of characteristics, such as the symptoms present, the size of the defect, and the patient's desire to become pregnant. The ultrasonographic finding of an isthmocele in an asymptomatic woman not desiring offspring does not indicate any therapy. In the case of a symptomatic patient, not desirous of offspring and with a mild defect, it is appropriate to propose a medical estro-progestin or progestin therapy (also by means of intrauterine device), possibly in continuous regimen, in order to reduce or stop the menstrual flow. In case of failure of medical therapy, these patients can be proposed an operative hysteroscopy that aims to eliminate the margins of the defect, and, when they are realigned with the surrounding healthy tissue, the continuity of the cervical canal is regained and the correct passage of menstrual flow is restored. On the contrary, in the case of women in search of offspring or in the presence of a severe defect, it is appropriate to propose to the patient a surgical treatment that aims at the definitive correction of the defect through the excision of the present scar tissue and the packaging of a new uterine suture. This type of surgery allows for the use of two different surgical approaches: a vaginal approach, faster and with better postoperative recovery, and a laparoscopic approach. Our center is specialized in the vaginal surgical approach and, thanks to the presence of surgeons who perform this procedure routinely and with high experience in the field of vaginal surgery, excellent postoperative and reproductive results have been obtained.