Hysteroscopic Versus Laparoscopic Surgery in the Management of Post Cesarean Symptomatic Uterine Scar Defect: A Systematic Review and Meta-Analysis

Document Type : Review Article

Authors

1 Obstetrics and gynecology department , Faculty of medicine, Ain Shams University

2 Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Egypt

Abstract

Objectives: To assess the safety and effectiveness of laparoscopy and hysteroscopy in treating women with symptoms (e.g: abnormal uterine bleeding, infertility), or to prevent consequences from obstetrics.
Methods: Original papers on the surgical therapy of scar defect, published between 1950 and 2023 were systematically searched in PubMed/MEDLINE, Scopus, Embase, Science Direct, and Cochrane Library (no CRD4202417098). MedCalc 16.4.3 was used to perform the data synthesis. The GRADE methodology was employed to evaluate the corpus of evidence.
Results: 25 papers were found; 21 of them concentrated on a specific surgical procedure, and 4 of them contrasted several methods. A meta-analysis revealed that 85.00% of women (75.05–92.76%) reported improved symptoms following hysteroscopic correction, and 92.77% (85.53–97.64%) following laparoscopic/robotic correction. The procedure with the least risk of hazards was hysteroscopic surgery (0.76%, 0.20–1.66%).
Conclusions: The safest and most successful course of action for patients with sufficient residual myometrial thickness covering the isthmocele may be hysteroscopic repair. When hysteroscopic treatment proves ineffective and a patient has a thinner remaining myometrium (less than 2.5 mm) over the defect, a laparoscopic method might be the better choice.

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