Hysteroscopic Resection Versus Laparoscopic Repair for Women with Caesarean Scar Defect Suffering from Postmenstrual Spotting, A Randomized Trial

Background: The prevalence of scar deformities following Cesarean sections (CSD) has risen significantly due to the global increase in Cesarean deliveries. Infertility, dysmenorrhea, dyspareunia, persistent pelvic pain, and postmenstrual uterine hemorrhage are some of the symptoms of these abnormalities. Various management strategies have been proposed for addressing these defects.
Objective: The current study aimed at assessing how well laparoscopic repair and hysteroscopic resection work to alleviate CSD symptoms, particularly postmenstrual spotting, against expectant management, in a randomized trial.
Methods: The study has been carried out from December 2019 to December 2023. This study included 45 women diagnosed with CSD using transvaginal sonohysterography. All participants had undergone at least six months of medical treatment (Using combined oral contraception and/or tranexamic acid) before being included. The women were randomly divided into three groups: One continuing medical treatment without additional intervention, and the other two undergoing surgical repair using either laparoscopic or hysteroscopic techniques. All participants were assessed three months post-surgery for symptom improvement and underwent ultrasonographic evaluation.
Results: Both laparoscopic repair and hysteroscopic resection of CSD significantly reduced three months after surgery, the number of days with postmenstrual spotting. Improvement in bleeding symptoms was observed in 93.3% of cases in both surgical groups. Additionally, the residual myometrial thickness (RMT) significantly increased preoperatively from 3.97 ± 0.97 mm to three months post-laparoscopic repair at 7.3 ± 1.45 mm.
Conclusions: Both laparoscopic repair and hysteroscopic resection effectively alleviated symptoms associated with CSD, particularly postmenstrual bleeding or spotting. Laparoscopic repair is favored for anatomical correction and improved ultrasonographic measurements of the scar defect.