METHODS:~Subjects: women in childbearing period with abnormal uterine bleeding or infertility attributed to post cesarean isthmocele (sample size to be calculated)~Preoperative evaluation: transvaginal ultrasound to exclude any other uterine or adnexal pathology, and to measure:~Distance from the external cervical os to the lower end of the isthmocele (A)~Distance from the external cervical os to the upper end of the isthmocele(B)~Length of the isthmocele (B-A)~Residual myometrial thickness (the least) of the isthmocele.~Routine preoperative workup.~The technique:~Postmenstrual~Spinal anesthesia~Sterilization of the perineum and vagina~Cervical dilation up to 8mm using Hegar's dilators~Marking the previously measured points A & B~Making 2 transverse incisions, one 5mm below A and the other 5 mm above B.~The rectangular area between the 2 incisions is excised while the Hegar's dilator number 8 in in situ.~Hemostasis is performed using diathermy.~The upper and lower edges of the incision are approximated using number 2/0 vicryl on cutting needle taking 3 to 4 interrupted sutures~The patients with uneventful postoperative course are discharged from hospital after 8 hours with doxycycline 100 mg bid for 5 days.~Sexual intercourse is avoided for 4 weeks postoperative~postoperative transvaginal ultrasound follow up; at 1 month postoperative.~Data will be statistically analyzed and results will be tabulated.
20 WOMEN WITH SYMPTOMATIC POSTCESAREAN ISTHMOCELE (NICHE) WILL BE RECRUITED EVALUATED AND SUBJECTED TO A VAGINAL REPAIR OF THE DEFECT, RESULTS WILL BE ANALYZED.