Isthmocele: Diagnosis & Advanced Laparoscopic/Hysteroscopic Treatment by Dr. Vatsal Thakral

Isthmocele, also known as a cesarean scar defect or niche, is a growing concern in gynecology today. It occurs when a defect or pouch forms at the site of a previous cesarean section scar on the uterus, usually in the lower uterine segment. While often asymptomatic, it can lead to troubling symptoms like abnormal bleeding, pelvic pain, and even infertility.

Dr. Vatsal Thakral, a trusted name in Gurgaon with over 7 years of experience, offers specialized diagnosis and minimally invasive surgical management of Isthmocele. As a Gynae Laparoscopic and Hysteroscopic Surgeon, his advanced techniques ensure safe, scarless, and effective treatment options that restore both comfort and fertility in affected women.

What is an Isthmocele?

An Isthmocele is a uterine defect that develops in the scar tissue following a cesarean delivery. This defect may form a pouch that retains menstrual blood and can interfere with normal uterine function.

While not every woman with a prior C-section develops Isthmocele, it’s increasingly diagnosed due to improved imaging and a growing awareness among gynecologists.

Common Symptoms of Isthmocele

• Postmenstrual spotting
• Prolonged menstrual bleeding
• Pelvic pain or discomfort
• Infertility or secondary infertility
• Discomfort during intercourse
• Recurrent miscarriage or pregnancy complications

Some women may remain asymptomatic, and the defect is found incidentally during evaluation for other gynecologic issues or infertility.

Causes and Risk Factors

The most common cause of Isthmocele is a cesarean section. Several factors can increase the likelihood of developing this defect:

• Low uterine incision during C-section
• Poor healing or closure of the uterine wall
• Multiple cesarean deliveries
• Infections during recovery
• Thin uterine lining at the incision site

Diagnosis of Isthmocele

Isthmocele is usually diagnosed using imaging techniques:

• Transvaginal Ultrasound (TVUS) – First-line imaging tool for visualizing the scar defect
• Saline Infusion Sonohysterography (SIS) – Provides better visualization of the uterine cavity
• MRI or Hysteroscopy – In some cases, these are used to get a more detailed view

Dr. Vatsal Thakral performs a thorough diagnostic evaluation using the latest imaging and hysteroscopic tools to confirm the presence, size, and impact of Isthmocele.

Treatment Options for Isthmocele

1. Hysteroscopic Isthmoplasty

• Ideal for small to moderate defects
• A camera-guided procedure performed through the vaginal canal
• No external incision
• Involves excising the scar tissue and reshaping the uterine wall
• Short recovery time

2. Laparoscopic Isthmoplasty

• Recommended for larger or deeper defects
• Minimally invasive surgery using small incisions in the abdomen
• Allows full repair of the scar and surrounding tissue
• Often combined with hysteroscopic view for accuracy

Dr. Vatsal Thakral’s expertise in both laparoscopic and hysteroscopic gynecologic surgeries ensures patients receive the safest and most appropriate surgical care with minimal discomfort and quick recovery.

Why Timely Treatment Matters

Ignoring Isthmocele can result in:

• Ongoing discomfort or pain
• Difficulty conceiving or maintaining a pregnancy
• Increased risk of uterine rupture in future pregnancies

Early diagnosis and expert treatment can improve quality of life, restore fertility, and reduce risks in future childbirth.