Evaluation of the relationship between isthmocele size and inflammatory, hemogram and coagulation markers in symptomatic isthmocele patients

AIM: Isthmocele is a pouch-like defect located at the cesarean scar site and may lead to abnormal uterine bleeding, pelvic pain, and infertility. This study aimed to evaluate the relationship between isthmocele size and grade and inflammatory markers (NLR, MLR, PLR, SII), hemogram parameters, and coagulation indicators (PT, aPTT, INR) in symptomatic patients. MATERIALS AND METHODS: A total of 382 patients who underwent surgery between January 2021 and June 2025 were retrospectively evaluated. Patients were grouped as hysteroscopic isthmoplasty (Isthmocele-1), laparoscopic isthmoselectomy (Isthmocele-2), and a control group without isthmocele. Demographic data, inflammatory indices, coagulation parameters, and hematological values obtained from the hospital information system were compared among the groups. RESULTS: No significant differences were observed among the groups in NLR, PLR, SII, PT, aPTT, or INR values (p>0.05). WBC, neutrophil, and monocyte levels were significantly lower in the isthmocele group (p=0.048; p=0.008; p=0.012). A positive correlation was identified between MLR and isthmocele area in the Isthmocele-2 group (r=0.559; p=0.010), while a weak negative correlation was found between platelet count and isthmocele area in the Isthmocele-1 group (r=–0.187; p=0.012). Smoking showed no significant impact on hematological parameters. CONCLUSION: The findings indicate that systemic inflammatory response is not a key determinant in isthmocele development. The process may be more closely related to impaired local tissue healing, microcirculatory disturbance, and reduced regenerative capacity. Although no significant differences were observed in systemic inflammatory markers, the correlation between MLR and defect size may reflect mild systemic expression of localized inflammation. Optimizing surgical techniques and supporting local tissue repair may be more effective than systemic anti-inflammatory approaches. Keywords: Isthmocele, MLR, NLR, PLR, SII.