Comparison of long-term clinical effect and re-pregnant outcomes between hysteroscopic resection and laparoscopic defect repair in patients with non-severe cesarean scar defect: a retrospective study.

Objective: To evaluate and compare the long-term therapeutic effect and the re-pregnant outcomes of hysteroscopic resection and laparoscopic defect repair in the treatment of non-severe cesarean scar defect (CSD).

Methods: The clinical data of 154 CSD patients whose residual myometrium thickness (RMT) ≥ 3 mm that treated at Maternal and Child Health Hospital of Hubei Province from January 2019 to May 2022 were retrospectively analyzed (74 accepted hysteroscopic resection and 80 received laparoscopic defect repair). We compared the general clinical data, laboratory tests, surgical related indicators and perioperative complications of two groups of patients, followed up and recorded the menstrual days at the 3rd, 6th, and 12th months after surgery, as well as the obstetric outcomes of re-pregnant patients.

Results: The surgical duration, intraoperative bleeding, postoperative vaginal bleeding days, hospital stay, and total treatment cost in hysteroscopic group were all obviously lower than those in laparoscopic group. More importantly, the incidence of postoperative complications such as fever and pelvic pain was also significantly lower in patients undergoing hysteroscopic surgery than those undergoing laparoscopic surgery. In terms of menstrual improvement, at the postoperative 3rd,6th and 12th month, the patients of hysteroscopic group had shorter menstrual days than laparoscopic group. Additionally, the postoperative re-pregnancy rate of hysteroscopic group (61.29%) was higher than that of laparoscopic group (55%). No serious obstetric complications such as placenta implantation and uterine rupture occurred in the re-pregnant patients of both groups.

Conclusions: Although both hysteroscopic resection and laparoscopic defect repair have good clinical effects on improving the symptoms of non-severe CSD patients. But in contrast, the hysteroscopic resection displays the advantages of minimal trauma, shorter surgical time, less intraoperative bleeding, shorter hospital stay, lower treatment costs, faster postoperative recovery, lower incidence of postoperative complications, and higher re-pregnancy rate. Hence, hysteroscopic resection is safe and effective, and could be the first choice for the treatment of no-severe CSD patients.