Surgical Technique for Excision of Cesarean-Scar Endometriosis: Approach and Considerations

Objective: Cesarean-scar endometriosis (CSE) is a challenging and increasingly common condition characterized by endometrial tissue on the surgical scar following a cesarean section. Surgical excision is the primary treatment modality. This article and video highlight the surgical technique for excising CSE, emphasizing key considerations for achieving optimal outcomes. Methods: The surgical approach to excising CSE is demonstrated in 2 patients who presented with tender nodules at the sites of their previous cesarean-section scars and who had increased symptoms during menstruation. Their preoperative workups involved ultrasound and magnetic resonance imaging scans to assess the size, location, and margins of the lesions. Results: The surgical steps demonstrated are: (1) marking the margin of the palpable endometriosis nodule; (2) excising the previous cesarean scar and performing subcutaneous dissection up to the encapsulated endometriosis lesion; (3) dissecting the lesion that is involved with the anterior rectus fascia and rectus muscle and performing resection with a 1-cm margin around the lesion; (4) performing a washout with 0.9% sodium chloride and betadine; (5) plicating the rectus muscles, using 1 Vicryl suture in an interrupted fashion; (6) placing a size-10 redivac drain to minimize hematoma formation; and (7) closing the anterior rectus fascia with a nonabsorbable 1-0 looped nylon suture to reduce the risk of hernia formation. Conclusions: Surgical excision with an adequate margin is the most-effective treatment for CSE. Collaborative care with gynecologists specialized in endometriosis and plastic surgeons is recommended. (J GYNECOL SURG 20XX:000)