Comparison of the effectiveness and pregnancy outcomes of the "incise and suture" versus "fold and suture" methods in hysteroscopic-assisted laparoscopic treatment of previous cesarean scar defect: A retrospective cohort study.

Objective: To investigate the clinical efficacy of the hysteroscopic-assisted laparoscopic incised-suture versus folded-suture methods at the cesarean incision site for the treatment of previous cesarean scar defects (PCSD) and to evaluate pregnancy outcomes.

Methods: This was a retrospective analysis of 95 patients with PCSD who underwent hysteroscopic-assisted laparoscopic surgery between June 2021 and September 2024 at the Third Xiangya Hospital of Central South University.

Results: There were no significant differences in population characteristics such as age and number of cesarean sections (P > 0.05). The folded-suture group had shorter operation time (39.03 ± 1.17 vs. 60.28 ± 1.14 min, P < 0.001) and volume of intraoperative hemorrhage (5.00, 2.00 vs. 20.00, 10.00 mL, P < 0.001). There were no statistically significant variations in the cure or effective rates regarding menstrual abnormalities between the two groups at 3 months, 6 months, 1-year post-surgery and the terms of overall clinical efficacy (P > 0.05). The overall effective rates for the incised- and folded-suture groups were 76.4% and 75.0%, respectively. In comparison to the incised-suture group, the desire to maintain postoperative fertility in the folded-suture group was significantly greater (odds ratio [OR] 8.33, 95% confidence interval [CI]: 2.27-30.58, P < 0.001), and the average time after surgery to pregnancy was shorter (5.60 ± 0.72 vs. 11.00 ± 2.70 months, P < 0.05). No substantial difference was observed in the pregnancy outcomes between the two groups.

Conclusion: Hysteroscopic-assisted laparoscopic cesarean incised and folded suturing are both effective, with folded suturing being more safe and more suitable for patients requiring short-term fertility.