Paths to Recovery: Study Examining Surgical Options for Non-Severe Cesarean Scar Defects

Comparative analysis of hysteroscopic resection versus laparoscopic defect repair for treating non-severe cesarean scar defect (CSD) reveals significant distinctions in long-term outcomes and re-pregnancy rates. CSD, a complication after cesarean section characterized by a depression at the uterine incision site, is associated with symptoms like abnormal uterine bleeding and chronic pelvic pain. Although pharmacological treatments can alleviate symptoms temporarily, surgical interventions are often necessary for symptom resolution and anatomical restoration.

A recent retrospective study designed to identify a more effective surgical approach for treating non-severe cesarean scar defect (CSD). A cohort of 154 patients diagnosed with non-severe CSD underwent either hysteroscopic resection (74 patients) or laparoscopic defect repair (80 patients). Surgical outcomes showed that hysteroscopy resulted in shorter operation time, less intraoperative bleeding, and a reduced duration of postoperative vaginal bleeding compared to laparoscopy, in conjunction with a lower rate of complications (4.05% vs. 13.75%).

Postoperative Assessments and Symptom Improvement

Postoperative assessments, conducted via vaginal ultrasound two months post-surgery, indicated that the residual myometrium thickness (RMT) significantly increased in the laparoscopic group while showing no notable change in the hysteroscopic cohort. In terms of menstrual symptom improvement, both groups demonstrated reduced bleeding duration; however, hysteroscopic patients exhibited statistically superior outcomes.

Re-pregnancy Rates and Outcomes

Regarding re-pregnancy, the hysteroscopic group showed a higher re-pregnancy rate (61.29%) than the laparoscopic group (55%). Among those attempting to conceive again, the hysteroscopic group had a higher proportion of successful pregnancies, with no significant differences in complications during re-pregnancy, including rates of uterine rupture, placenta previa, or cesarean scar pregnancy.

Conclusion and Future Recommendations

The findings underscore that while both surgical approaches effectively manage symptoms and can result in successful pregnancies, hysteroscopic resection is associated with a higher re-pregnancy rate, lower complication rates, and reduced healthcare costs, suggesting it as the preferable option for non-severe CSD. Despite limitations including a relatively small sample size and retrospective design, the study reinforces the need for comprehensive and individualized treatment plans based on patient characteristics and fertility desires. Further large-scale, prospective studies are suggested to derive more definitive conclusions regarding optimal surgical interventions for CSD.

Key Points

- Comparative analysis highlights significant differences between hysteroscopic resection and laparoscopic defect repair for non-severe cesarean scar defect (CSD), indicating that both techniques improve long-term outcomes and re-pregnancy rates, yet with varying efficacies.

- A cohort of 154 patients diagnosed with non-severe CSD underwent either surgical approach, where hysteroscopic resection led to shorter operation times, decreased intraoperative bleeding, and a reduced period of postoperative vaginal bleeding, resulting in a lower complication rate (4.05% vs. 13.75%).

- Postoperative evaluations, including vaginal ultrasound at two months, revealed a significant increase in residual myometrium thickness (RMT) in the laparoscopic cohort, whereas no notable change was observed in the hysteroscopic group, which correlated with superior menstrual symptom improvement in hysteroscopic patients.

- Re-pregnancy data indicated a higher re-pregnancy rate in the hysteroscopic group (61.29%) compared to 55% in the laparoscopic group, along with a greater proportion of successful pregnancies among those attempting conception, with comparable rates of complications like uterine rupture and placenta previa.

- The results suggest that hysteroscopic resection is preferable for non-severe CSD, being associated with higher re-pregnancy outcomes, lower complication rates, and reduced healthcare costs, thereby emphasizing its effectiveness as a surgical treatment option.

- Limitations of the study, including the relatively small sample size and retrospective design, highlight the necessity for larger, prospective studies to establish definitive treatment recommendations, emphasizing the importance of individualized treatment approaches based on patient profiles and fertility goals.

Reference -

Shiyu Cheng et al. (2025). 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. *BMC Pregnancy And Childbirth*, 25. https://doi.org/10.1186/s12884-025-07667-0.