Cesarean delivery plays a crucial role in managing obstructed labor and serious pregnancy complications or complications, and in reducing maternal and child morbidity and mortality. However, over the past 30 years, the cesarean delivery rate in China has increased year by year due to various factors, and in 2010, the WHO Maternal and Child Health Survey in Asia reported that the cesarean delivery rate in China was as high as 46.2%, with 11.7% of cesarean deliveries without indications, making it the highest reported rate in the world. Such a widespread practice of cesarean delivery not only interferes with the normal physiological process of labor and delivery, but the procedure itself brings complications to both the mother and the fetus. This is not only a medical problem, but it has evolved into a social problem. At present, due to the factors of performing cesarean section, the maternal long-term complications mainly include scar endometriosis, hysterotomy scar pregnancy, hysterotomy diverticulum, chronic pelvic pain and so on. Among them, diverticulum is also called cesarean scar defect or diverticulum (CSD), which is a new and special type of disease. At present, there are no epidemiological studies on CSD in China, and the majority of gynecologists are not very clear about how to diagnose CSD early, especially what kind of treatment should be given to patients, which is almost a blind spot. Diverticulum is a limited dilatation or cystic protrusion of the mucosa of a cavity-like organ that protrudes outward into the wall. They are common in the digestive system in the esophagus, duodenum, and jejunum, and in the urinary system in the bladder, and can also occur in tubal diverticula, but uterine diverticula are very common. Congenital uterine diverticula are associated with abnormal embryonic development, while post-cesarean section diverticula (CSD) are acquired diverticula that are poorly healing diseases of the uterine incision. The identified etiology is mainly related to poor healing of the incisional muscle due to a variety of factors that eventually form. The main clinical manifestations of diverticulosis are menstrual dribbling and infertility, some patients may have chronic lower abdominal pain or menstrual abdominal pain, and these clinical symptoms cannot be explained by other diseases such as dysfunctional uterine bleeding, endometrial polyps, pelvic inflammatory disease, etc. Prolonged menstruation is the most important clinical manifestation of CSD. Patients with regular preoperative menstrual cycles, after the conversion of labor and delivery, present with prolonged periods and dripping menstrual blood, which last for different lengths of time, usually 10-20 days. About 15% of patients also exhibit only mid-cycle bleeding. Prolonged menstruation is associated with impaired contraction of the uterus and the degree of blood accumulation in the diverticulum. The larger the incisional diverticulum, the more pronounced the symptoms and the longer the duration of dripping menstruation, or the uncoordinated contraction of the uterine muscle layer leads to the accumulation of some menstrual blood in the diverticulum, and the residual menstrual blood in the diverticulum begins to flow slowly after the patient’s normal menstruation, resulting in dripping menstruation. The prolonged menstrual period seriously affects the quality of life of the patient, affects the harmonious life of the couple, and is not a stabilizing factor for the family and society. It should also be noted that CSD, due to the long-term inflammation of the endometrium, affects the fertilization of the egg, making some women become sterile; even a few women who are pregnant again, the fertilized egg happens to be planted in the diverticulum site, becoming diverticular pregnancy, although it is relatively rare, but this part of patients to occur in early to mid-term pregnancy of uterine rupture, causing serious intra-abdominal bleeding, threatening the lives of patients. There are no accepted criteria for the diagnosis of CSD. In addition to history and clinical manifestations, imaging tests are required, including transvaginal ultrasound, hysterosalpingography and hysteroscopy. Currently, transvaginal ultrasound is the most predominant and commonly used imaging test. There is no consensus on the treatment of CSD, which is mainly divided into surgical treatment and primary conservative treatment. Pharmacological treatment mainly with contraceptive pills is less effective for most patients with CSD formed by anatomical defects, and if the patient has contraindications to contraceptive pills or refuses to use them, and the proportion of women using oral contraceptives for family planning is not very high in China, making surgical treatment particularly important. Three surgical options have been reported, hysteroscopic electrocoagulation, combined hysteroscopic repair of diverticula, and transvaginal repair of diverticula. However, the efficacy of hysteroscopic electrocoagulation is uncertain and can easily cause bladder damage. And the second one, combined hysteroscopic surgery, I think this surgery also has some limitations, firstly, the site of CSD is low, due to the surgical reason of cesarean delivery, covered bladder muscle layer, in most cases, the diameter of CSD is not more than 10 mm, even under hysteroscopic light source irradiation, sometimes it is still more difficult to confirm the site of CSD; secondly, after determining the site of CSD, in order to better expose the complete CSD site, it is necessary to open the bladder peritoneal reflex and push down the bladder, which, to a certain extent, may increase the possibility of intraoperative bleeding and organ damage; third, to suture this CSD site under laparoscopy, theoretically, it is necessary to cut away the surrounding scar tissue and suture the fresh muscle tissue together, this surgical operation process, done under laparoscopy, without strong surgical skills, in most cases is This surgical procedure, done under laparoscopy, is impossible to be completed in a fine manner without strong surgical skills in most cases, which means that it is difficult to ensure the surgical treatment effect. There are relatively few reports on this subject in China and abroad. I have tried to perform transvaginal repair of CSD for CSD patients based on my many years of vaginal surgery. After several cases of patients, I found that the advantages of vaginal surgery are, firstly, very accurate localization of the CSD site, secondly, very clear exposure of the CSD site and complete repair after excision of the scar, and thirdly, the use of the natural cavity of the vagina, which is the most minimally invasive surgery, and faster recovery of the patient after surgery. At present, in long-term follow-up, the patients’ menstruation is controlled within 7 days, and the efficacy is very good. In clinical practice, I also found that after actually separating the bladder-cervical interval and pushing up the bladder, it is possible to clearly expose the lower end of the uterine body and then perform the operation completely extraperitoneally, that is, it is not necessary to enter the abdominal cavity and then perform the operation, if this is feasible, then it will be more beneficial to the patient’s recovery.