Analysis of Efficacy and Safety Profile of Vaginal Surgery and Hysteroscopic Electric Resection in the Management of Post-Cesarean Section Isthmocele: a Systematic Review.

Introduction: The present study has discussed the increasing prevalence of isthmocele, which is related to growing cesarean sections. It is also due to enhanced diagnostics, which includes transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) that significantly affects women's reproductive health and quality of life. Management differs by defect size, from hysteroscopic to laparoscopic repair, which also highlights the necessity for standardized protocols.

Aim: s and objective: To evaluate the efficacy and safety profile of vaginal surgery and hysteroscopic electric resection in the management of post-cesarean section isthmocele.

Methods: This systematic review analyzed the efficacy and safety of vaginal surgery and hysteroscopic electrotomy for managing post-cesarean section isthmocele. Relevant studies were identified from PubMed, Embase, Cochrane Library and Web of Science using terms like "cesarean scar", "isthmocele" and "hysteroscopic electrotomy". We conducted the present review using a PRISMA flowchart, which resulted in the inclusion of eight studies after screening and eligibility assessment.

Results: The hysteroscopic method consistently shows a lower risk compared to the vaginal method, with a pooled risk ratio of 0.71 (95% CI 0.59-0.85), indicating statistical significance. Heterogeneity analysis reveals no significant variability among studies (I² = 0%), suggesting consistent results. Additionally, the hysteroscopic group outperforms the vaginal group in efficacy for diverticulum recovery, supporting hysteroscopy as the more effective approach across both outcomes.

Conclusion: The present study has concluded that the hysteroscopic electric resection was safer and more efficient in the management of isthmocele among patients who underwent a cesarean section.