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Background <p>The prevalence of cesarian scar defects (CSD) is increasing worldwide mainly due to the increasing rates of cesarian deliveries (CD). While hysteroscopic (H) and laparoscopic (L) are both popular approaches in the management of CSD, the superiority of one over the other remains debated. Therefore, this meta-analysis will compare H and L approaches for CSD treatment.</p> Methods <p>PubMed, Cochrane, and Google Scholar were queried through May 2026. Inclusion criteria consisted of studies comparing the outcomes of CSD management between H and L approaches. Extracted data included adverse events (overall complications, chronic pelvic pain, abnormal bleeding, dyspareunia, dysmenorrhea), CSD parameters (change in isthmocele depth, change in residual myometrial thickness (RMT)), surgical parameters (operative time, estimated blood loss (EBL), length of stay (LOS), and cost), and pregnancy outcomes among patients desiring pregnancy (subsequent pregnancies, abortions, premature deliveries, and term deliveries).</p> Results <p>Ten studies met the inclusion criteria including 798 patients, with 361 being in the H group and 437 in the L group. Patients in the H group had a lower rate of overall complications (Odds-Ratio = 0.24, <i>p</i> = 0.02), shorter operative time (Mean difference= -55.94&#xa0;min, <i>p</i>&lt;0.001), less EBL (Mean difference= -37.73&#xa0;ml; <i>p</i>&lt;0.001), shorter LOS (Mean difference= -2.84 days; <i>p</i>&lt;0.001), and less costs (Mean difference= $-1310; <i>p</i>&lt;0.001). However, the H group also had less change in RMT compared to the L group (Mean difference= -2.60&#xa0;mm; <i>p</i> = 0.0007). There were no differences in the remaining outcomes.</p> Conclusion <p>Patients undergoing hysteroscopic management of CSD had shorter operative time, shorter length of stay, less blood loss, less costs, and less complications. However, they also had less improvement in RMT. Nevertheless, both techniques did not differ in post-operative symptoms, adverse events, or pregnancy-related outcomes, making them both a viable option for the management of CSD.</p> Trial registration <p>Not applicable.</p>

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Hysteroscopic vs. laparoscopic management of cesarian scar defect: a meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月28日

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  • Rahaf Aldiab,
  • Majd Alswian,
  • Ammar Halawani,
  • Sula Almazrou,
  • Hajar Meshal Al-Shammari,
  • Ghaidaa Alsayed,
  • Sarah Hussain Al-Wadai,
  • Kayan Munahi Alotaibi,
  • Zaid Bin Sahaq,
  • Ralph Chalhoub,
  • Alaa Daher,
  • Salman Ashraf Alshahed

摘要

Background

The prevalence of cesarian scar defects (CSD) is increasing worldwide mainly due to the increasing rates of cesarian deliveries (CD). While hysteroscopic (H) and laparoscopic (L) are both popular approaches in the management of CSD, the superiority of one over the other remains debated. Therefore, this meta-analysis will compare H and L approaches for CSD treatment.

Methods

PubMed, Cochrane, and Google Scholar were queried through May 2026. Inclusion criteria consisted of studies comparing the outcomes of CSD management between H and L approaches. Extracted data included adverse events (overall complications, chronic pelvic pain, abnormal bleeding, dyspareunia, dysmenorrhea), CSD parameters (change in isthmocele depth, change in residual myometrial thickness (RMT)), surgical parameters (operative time, estimated blood loss (EBL), length of stay (LOS), and cost), and pregnancy outcomes among patients desiring pregnancy (subsequent pregnancies, abortions, premature deliveries, and term deliveries).

Results

Ten studies met the inclusion criteria including 798 patients, with 361 being in the H group and 437 in the L group. Patients in the H group had a lower rate of overall complications (Odds-Ratio = 0.24, p = 0.02), shorter operative time (Mean difference= -55.94 min, p<0.001), less EBL (Mean difference= -37.73 ml; p<0.001), shorter LOS (Mean difference= -2.84 days; p<0.001), and less costs (Mean difference= $-1310; p<0.001). However, the H group also had less change in RMT compared to the L group (Mean difference= -2.60 mm; p = 0.0007). There were no differences in the remaining outcomes.

Conclusion

Patients undergoing hysteroscopic management of CSD had shorter operative time, shorter length of stay, less blood loss, less costs, and less complications. However, they also had less improvement in RMT. Nevertheless, both techniques did not differ in post-operative symptoms, adverse events, or pregnancy-related outcomes, making them both a viable option for the management of CSD.

Trial registration

Not applicable.