Comparing Laparoscopic and Hysteroscopic Surgical Treatments for Isthmocele: A Prospective Cohort

Objectives: To evaluate clinical outcomes of laparoscopic and hysteroscopic surgical approaches in the treatment of symptomatic isthmocele and identify their associated factors.
Materials and Methods: Forty-six patients with symptomatic isthmocele diagnosed using transvaginal saline infusion sonohysterography were enrolled in this prospective cohort study. Patients underwent either laparoscopic or hysteroscopic isthmoplasty based on their residual myometrial thicknesses and fertility desires and were subsequently followed by clinical and ultrasonographic examinations.
Results: Twenty-two patients underwent laparoscopy, while twenty-four patients underwent hysteroscopic surgery. At baseline, there was no significant difference in mean age and years since the last cesarean section between the two groups. However, the hysteroscopy group had higher mean parity and previous C/Ss (p = 0.00, 0.03). The most common symptoms were abnormal uterine bleeding, infertility, and dysmenorrhea. The mean baseline residual myometrial thickness was significantly higher in the laparoscopy group (p = 0.00) and only the laparoscopic surgery led to a significant residual myometrial thickness increase in patients (p = 0.00). Both procedures significantly reduced abnormal uterine bleeding (p = 0.00), but only laparoscopy reduced infertility (p = 0.00), and hysteroscopy reduced dysmenorrhea (p = 0.03). Hysteroscopy showed better symptom resolution in younger patients (p = 0.01), while age did not affect laparoscopy outcomes.
Conclusion: Both approaches showed similar effectiveness in resolving abnormal uterine bleeding, with laparoscopy excelling in infertility resolution and hysteroscopy in dysmenorrhea resolution.