What was the scientific forum that took place in Vienna last October? Dr. Sayed Al Akhras: It is the 27th ESGE (European Society of Gynecological Endoscopy) annual congress that took place from the 7th to the 10th of October 2018, presenting a holistic approach towards women's health in terms of quality of life and innovation. How did Omam Hospital participate in this conference? Dr. Sayed Al-Akhras : Omam Hospital participated with seven scientific studies, including a paramount study of the first and largest uterine niche detected (uterine hernia), a study presenting niche & ectopic pregnancy, a study about laparoscopic measurement of fallopian tubes' lengths and its effect on fertility , a study on episiotomy scar endometriosis in a 54 Year old patient , a study on excision of Desmoid tumor (very rare ) during cesarean section, a study presenting the largest endometrioma in anterior abdominal wall (womb under my skin ), and lastly a study on endometriosis flare-up. What is uterine niche and why do you care about it? Dr. Sayed Al-Akhras: Uterine niche is a smooth muscle wall defect, similar to a hernia, acquired in cesarean scar due to incomplete healing of single or multiple uterine wall surgeries or the closure technique of the uterine muscle (the myometrium), this causes severe pain, abnormal uterine bleeding and sometimes delays of pregnancy, unfortunately no complete scientific studies have been carried out on the prevalence of this disease. What is the experience of Omam Hospital with uterine niche? Dr. Sayed Al-Akhras: We started to monitor uterine niche cases since 5 years ago, then we launched an awareness campaign through TV & social media, participated in several conferences during the last 3 years (2016 to 2018) presenting different results for many studies carried out at Omam Hospital for about 200 cases of uterine niche signs, laparoscopic repair and post-operative pain management and fertility. Is there is a relation between Uterine Niche and endometriosis? Dr. Sayed Al-Akhras: Of course! endometriotic cells could be transmitted during a cesarean section or any other uterine surgery during suturing the wound by a surgical needle, implanting endometriotic cells on the uterine wall. Under the influence of ovarian hormones those cells starts to produce its own menstruation on its implantation site which causes inflammation and severe pain. How can you repair Uterine niche by laparoscopy, and what are the risks on uterine wall especially during pregnancy? Dr. Sayed Al-Akhras: Laparoscopy is the latest minimally invasive surgery that doesn't cause adhesions and also the healing process is much faster. Uterine niche is repaired using this technique by performing a complete excision of the niche and its fibrosed edges, followed by uterine wall repair via intra-corporal sutures bringing the healthy edges of the uterine wall together, after which menstruation is stopped for 3 consecutive months to promote complete healing of the edges. Omam hospital didn't encounter any post-operative complications in post niche repair pregnancies. Considering the increasing number of uterine niche cases, Omam Hospital had started a clinical research study questioning the role of factors contributing to the development of uterine niche such as different uterine closure techniques performed, breast feeding versus bottle feed affecting post cesarean menstrual cycles as breast feeding halts menstruation allowing complete uterine wall healing whilst bottle feed does not.
