Assessment of the clinical outcomes and complications of hysteroscopic and laparoscopic approaches in the treatment of symptomatic isthmocele: An observational study

• Published in: International journal of gynecology and obstetrics 2023-12, Vol.163 (3), p.965-971
• Main Authors: Fatehnejad, Mina, Hadizadeh, Alireza, Tayebi, Amirhossein, Ayati, Aryan, Marjani, Narjes, Gheshlaghi, Parand, Asgari, Zahra, Hosseini, Reihaneh
• Format: Article
• Language: English
• Subjects: cesarean scar defect; hysteroscopy; Isthmocele; laparoscopy; niche; vaginal repair
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1002/ijgo.14926

Objectives To investigate the outcomes of patients undergoing laparoscopic or hysteroscopic approaches for isthmoplasty. Methods A total of 99 isthmocele patients with an average age of 38.45 ± 4.72 years were included in the 2 years of this retrospective cohort study. Forty‐five underwent laparoscopic and 54 underwent hysteroscopic isthmocele excision and myometrial repair. Results Pain scores were significantly higher in the hysteroscopy group before the procedure, but there were no significant pain score differences after the surgery. In 1 year of follow up, dysmenorrhea and dyspareunia were higher among hysteroscopy patients. Furthermore, hysteroscopy significantly improved postmenstrual spotting after surgery better than laparoscopy, but in the follow up, there was no significant difference between the two groups in this regard (mean rank for hysteroscopy vs. laparoscopy: 32.30 vs. 37.48, U = 418, P = 0.29). Conclusion In patients with a history of infertility, ectopic pregnancy, lower gravidity, lower parity, and a lower number of cesarean sections, laparoscopic isthmoplasty is preferred over the hysteroscopic approach. Both methods have similar effects on midcycle vaginal bleeding, duration of postmenstrual spotting, and pain. However, a higher rate of dyspareunia and dysmenorrhea could be associated with hysteroscopy. Synopsis Laparoscopic isthmoplasty is preferred to the hysteroscopic approach in individuals with a history of infertility, endometriosis, low body mass index, poor parity, and low CS.