Risk factors for cesarean scar endometriosis

Background: Cesarean scar endometriosis (CSE) is a rare complication (0.03%-1.7%) following cesarean sections, caused by endometrial tissue implantation in the incision site. Symptoms include abdominal mass, scar swelling, and cyclic pain. Risk factors for CSE development are not well understood, with existing studies often being descriptive case reports lacking homogeneity. Methods: This retrospective study investigated patients diagnosed with CSE who underwent surgical excision at a university-affiliated medical center. Data were collected through questionnaires and medical records. A control group of women who underwent cesarean sections on similar dates but without a history of CSE were used for comparison. Results: Compared to controls, more patients with CSE reported additional endometriosis symptoms (41.2% vs. 28.4%, p<0.05). Younger age at cesarean section (median: 32 vs. 35 years), prior cesarean sections, and urgent cesarean sections were all identified as risk factors. Local scar complications were the strongest risk factor (20.6% vs. 4.9%, p<0.001). Surgery offered pain relief for most patients, but 20% experienced symptom recurrence (repeat surgery needed in only 5.9%). The median symptom-free period was 41 months. While some fascia defects occurred after surgery (50%), mesh insertion was infrequent (10.3%). Postoperative complications (mainly seroma) occurred in 10.3%. Conclusion: CSE requires further research to improve understanding. Urgent cesarean sections, young age at surgery, prior cesarean sections, and local scar complications are significant risk factors. Surgical excision is the primary treatment, offering pain relief with low complication rates. Although recurrence can occur, repeat surgery is infrequent.