Clinical differences between adipose- and muscle-layer cesarean scar endometriosis: A retrospective observational study

TAŞ E. E., Halilzade M. İ., Doğanay M., YAVUZ ŞALA F. C.

International Journal of Gynecology and Obstetrics, 2025 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Publication Date: 2025
  • Doi Number: 10.1002/ijgo.70399
  • Journal Name: International Journal of Gynecology and Obstetrics
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, CAB Abstracts, CINAHL, EMBASE, Gender Studies Database, Public Affairs Index
  • Keywords: abdominal wall, CA125 antigen, cesarean section, endometriosis
  • Ankara Yıldırım Beyazıt University Affiliated: Yes

Abstract

Background/aim: This study evaluated cesarean section scar endometriosis (CSSE) characteristics and compared adipose- and muscle-layer CSSEs. Materials and methods: We analyzed 53 patients who underwent CSSE surgery between 2019-2024, with 38 (71.7%) having adipose-layer and 15 (28.3%) having muscle-layer CSSE. Results: Patients’ mean age was 33.4 ± 5.9 years. Symptoms began 40.4 ± 23.5 months after cesarean section. CSSE occurred at scar corners in 42 patients (79.2%) and midline in 11 (20.8%). Mean preoperative CA-125 was 24.1 ± 14.8 U/mL. Groups differed in symptoms, location, and CA-125 levels. Adipose-layer CSSE commonly presented with swelling at corners, while muscle-layer CSSE showed pain at midline. Muscle-layer CSSE had higher CA-125 levels (38.2 ± 19.2 vs. 18.5 ± 7.3 U/mL; P = 0.01). The CA-125 cutoff between groups was 30 U/mL. Pain (odds ratio [OR], 7.2; P = 0.03) and elevated CA-125 (≥30 U/mL) (OR, 19.6; P < 0.01) independently associated with muscle-layer CSSE. Conclusion: These findings may have important implications in clinical practice, potentially aiding in the localization of undefined lesions, surgical planning, and monitoring of recurrence risk.