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Comparison of Laparoscopic and Hysteroscopic Surgical Treatments for Isthmocele: A Prospective Cohort; [Istmoselde Laparoskopik Ve Histeroskopik Cerrahi Tedavilerin Karsilastirilmasi: Prospektif Bir Kohort] Publisher



Hosseini R1 ; Parsaei M2 ; Aliabad NR1 ; Daliri S3 ; Asgari Z1 ; Valian Z4 ; Hajiloo N5 ; Mirzaei S1 ; Bakhshalibakhtiari M6
Authors
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Authors Affiliations
  1. 1. Department of Laparoscopic Surgery, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Maternal, Fetal & Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Department of Obstetrics and Gynecology, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
  5. 5. Department of Obstetrics and Gynecology, Kowsar Women’s Hospital, Urmia University of Medical Sciences, Urmia, Iran
  6. 6. Department of Gynecology and Obstetrics, Shohada Tajrish Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Source: Turkish Journal of Obstetrics and Gynecology Published:2024


Abstract

Objective: To evaluate the clinical outcomes of laparoscopic and hysteroscopic surgical approaches for treating 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 and 24 underwent hysteroscopic surgery. At baseline, there was no significant difference in the mean age and years since the last cesarean section between the two groups. However, the hysteroscopy group had a higher mean parity and previous cesarean sections (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 laparoscopic surgery led to a significant increase in residual myometrial thickness 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), whereas 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 excelling in dysmenorrhea resolution. © 2024 The Author.
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