Assessment of the Clinical Outcomes and Complications of Hysteroscopic and Laparoscopic Approaches in the Treatment of Symptomatic Isthmocele: An Observational Study Publisher Pubmed



Fatehnejad M¹ ; Hadizadeh A² ; Tayebi A² ; Ayati A² ; Marjani N¹ ; Gheshlaghi P¹ ; Asgari Z¹ ; Hosseini R¹ Show Affiliations
Source: International Journal of Gynecology and Obstetrics Published:2023

Abstract

Objectives: To investigate the outcomes of patients undergoing laparoscopic or hysteroscopic approaches for isthmoplasty. Methods: A total of 99 isthmocele patients with an average age of 38.45 ± 4.72 years were included in the 2 years of this retrospective cohort study. Forty-five underwent laparoscopic and 54 underwent hysteroscopic isthmocele excision and myometrial repair. Results: Pain scores were significantly higher in the hysteroscopy group before the procedure, but there were no significant pain score differences after the surgery. In 1 year of follow up, dysmenorrhea and dyspareunia were higher among hysteroscopy patients. Furthermore, hysteroscopy significantly improved postmenstrual spotting after surgery better than laparoscopy, but in the follow up, there was no significant difference between the two groups in this regard (mean rank for hysteroscopy vs. laparoscopy: 32.30 vs. 37.48, U = 418, P = 0.29). Conclusion: In patients with a history of infertility, ectopic pregnancy, lower gravidity, lower parity, and a lower number of cesarean sections, laparoscopic isthmoplasty is preferred over the hysteroscopic approach. Both methods have similar effects on midcycle vaginal bleeding, duration of postmenstrual spotting, and pain. However, a higher rate of dyspareunia and dysmenorrhea could be associated with hysteroscopy. © 2023 International Federation of Gynecology and Obstetrics.