A comparison between laparoscopy and hysteroscopy approaches in the treatment of symptomatic isthmocele: A systematic review and meta-analysis

Objective

To compare the clinical outcomes of laparoscopy and hysteroscopy in the treatment of symptomatic isthmocele using a systematic review and meta-analysis.

Methods

A comprehensive search of PubMed, Scopus, and Web of Science was performed until November 11, 2024. Studies evaluating outcomes of laparoscopy or hysteroscopy intervention for treating symptomatic isthmocele were included in this study. A random-effects model was employed for heterogeneous data. The study is registered in PROSPERO with registration number CRD420251028603.

Results

Nine studies involving 797 patients were included. Hysteroscopy demonstrated significantly less intraoperative blood loss (SMD: −2.28, 95 % CI: −3.65 to −0.90) and shorter hospital stays (SMD: −2.62, 95 % CI: −3.52 to −1.72), but the operative time difference was non-significant. Both approaches were equally effective in symptom resolution and defect repair (OR: 0.80, 95 % CI: 0.21–2.97). However, laparoscopic repair was associated with better outcomes for dysmenorrhea improvement (OR: 3.46, 95 % CI: 1.42–8.45) and higher postoperative pregnancy rates (OR: 4.17, 95 % CI: 1.89–9.09). High heterogeneity was noted in some outcomes, reflecting variability in study designs and populations.

Conclusions

Both laparoscopy and hysteroscopy are effective in treating symptomatic isthmocele, with each approach offering distinct advantages. Hysteroscopy is less invasive with faster recovery and better fertility.