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Peer-reviewedCC BYBMC pregnancy and childbirth

Hysteroscopic vs. laparoscopic management of cesarian scar defect: a meta-analysis.

  • Rahaf Aldiab1
  • Majd Alswian2
  • Ammar Halawani3
  • Sula Almazrou4
  • Hajar Meshal Al-Shammari5
  • Ghaidaa Alsayed3
  • Sarah Hussain Al-Wadai6
  • Kayan Munahi Alotaibi7
  • Zaid Bin Sahaq4
  • Ralph Chalhoub8
  • Alaa Daher9
  • Salman Ashraf Alshahed10
10 affiliations
  1. 1College of Medicine, Alfaisal University, Riyadh, Saudi Arabia. [email protected].
  2. 2College of Medicine, Sulaiman Alrajhi University, Al Bukayriyah, Saudi Arabia.
  3. 3College of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
  4. 4College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
  5. 5College of Medicine, Vision College, Riyadh, Saudi Arabia.
  6. 6College of Medicine, King Khalid University, Abha, Saudi Arabia.
  7. 7College of Medicine, King Faisal University, Hofuf, Saudi Arabia.
  8. 8Department of Obstetrics and Gynecological Surgery, Hotel Dieu de France, Beirut, Lebanon.
  9. 9Department of Obstetrics and Gynecological Surgery, American University of Beirut, Beirut, Lebanon.
  10. 10Department of Obstetrics and Gynecological Surgery, King Fahad Medical City, Riyadh, Saudi Arabia.
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Abstract

Background

The prevalence of cesarian scar defects (CSD) is increasing worldwide mainly due to the increasing rates of cesarian deliveries (CD). While hysteroscopic (H) and laparoscopic (L) are both popular approaches in the management of CSD, the superiority of one over the other remains debated. Therefore, this meta-analysis will compare H and L approaches for CSD treatment.Methods

PubMed, Cochrane, and Google Scholar were queried through May 2026. Inclusion criteria consisted of studies comparing the outcomes of CSD management between H and L approaches. Extracted data included adverse events (overall complications, chronic pelvic pain, abnormal bleeding, dyspareunia, dysmenorrhea), CSD parameters (change in isthmocele depth, change in residual myometrial thickness (RMT)), surgical parameters (operative time, estimated blood loss (EBL), length of stay (LOS), and cost), and pregnancy outcomes among patients desiring pregnancy (subsequent pregnancies, abortions, premature deliveries, and term deliveries).Results

Ten studies met the inclusion criteria including 798 patients, with 361 being in the H group and 437 in the L group. Patients in the H group had a lower rate of overall complications (Odds-Ratio = 0.24, p = 0.02), shorter operative time (Mean difference= -55.94 min, p<0.001), less EBL (Mean difference= -37.73 ml; p<0.001), shorter LOS (Mean difference= -2.84 days; p<0.001), and less costs (Mean difference= $-1310; p<0.001). However, the H group also had less change in RMT compared to the L group (Mean difference= -2.60 mm; p = 0.0007). There were no differences in the remaining outcomes.Conclusion

Patients undergoing hysteroscopic management of CSD had shorter operative time, shorter length of stay, less blood loss, less costs, and less complications. However, they also had less improvement in RMT. Nevertheless, both techniques did not differ in post-operative symptoms, adverse events, or pregnancy-related outcomes, making them both a viable option for the management of CSD.Trial registration

Not applicable.

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Cite

BibTeXRIS
BibTeX
@article{aldiab2026hysteroscopic,
  title = {{Hysteroscopic vs. laparoscopic management of cesarian scar defect: a meta-analysis.}},
  author = {Rahaf Aldiab and Majd Alswian and Ammar Halawani and Sula Almazrou and Hajar Meshal Al-Shammari and Ghaidaa Alsayed and Sarah Hussain Al-Wadai and Kayan Munahi Alotaibi and Zaid Bin Sahaq and Ralph Chalhoub and Alaa Daher and Salman Ashraf Alshahed},
  journal = {BMC pregnancy and childbirth},
  year = {2026},
  month = jul,
  doi = {10.1186/s12884-026-09729-3},
  url = {https://europepmc.org/article/MED/42958131},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Hysteroscopic vs. laparoscopic management of cesarian scar defect: a meta-analysis.
AU  - Rahaf Aldiab
AU  - Majd Alswian
AU  - Ammar Halawani
AU  - Sula Almazrou
AU  - Hajar Meshal Al-Shammari
AU  - Ghaidaa Alsayed
AU  - Sarah Hussain Al-Wadai
AU  - Kayan Munahi Alotaibi
AU  - Zaid Bin Sahaq
AU  - Ralph Chalhoub
AU  - Alaa Daher
AU  - Salman Ashraf Alshahed
PY  - 2026
DA  - 2026/07/28
JO  - BMC pregnancy and childbirth
DO  - 10.1186/s12884-026-09729-3
UR  - https://europepmc.org/article/MED/42958131
AB  - Background  The prevalence of cesarian scar defects (CSD) is increasing worldwide mainly due to the increasing rates of cesarian deliveries (CD). While hysteroscopic (H) and laparoscopic (L) are both popular approaches in the management of CSD, the superiority of one over the other remains debated. Therefore, this meta-analysis will compare H and L approaches for CSD treatment.Methods  PubMed, Cochrane, and Google Scholar were queried through May 2026. Inclusion criteria consisted of studies comparing the outcomes of CSD management between H and L approaches. Extracted data included adverse events (overall complications, chronic pelvic pain, abnormal bleeding, dyspareunia, dysmenorrhea), CSD parameters (change in isthmocele depth, change in residual myometrial thickness (RMT)), surgical parameters (operative time, estimated blood loss (EBL), length of stay (LOS), and cost), and pregnancy outcomes among patients desiring pregnancy (subsequent pregnancies, abortions, premature deliveries, and term deliveries).Results  Ten studies met the inclusion criteria including 798 patients, with 361 being in the H group and 437 in the L group. Patients in the H group had a lower rate of overall complications (Odds-Ratio = 0.24, p = 0.02), shorter operative time (Mean difference= -55.94 min, p<0.001), less EBL (Mean difference= -37.73 ml; p<0.001), shorter LOS (Mean difference= -2.84 days; p<0.001), and less costs (Mean difference= $-1310; p<0.001). However, the H group also had less change in RMT compared to the L group (Mean difference= -2.60 mm; p = 0.0007). There were no differences in the remaining outcomes.Conclusion  Patients undergoing hysteroscopic management of CSD had shorter operative time, shorter length of stay, less blood loss, less costs, and less complications. However, they also had less improvement in RMT. Nevertheless, both techniques did not differ in post-operative symptoms, adverse events, or pregnancy-related outcomes, making them both a viable option for the management of CSD.Trial registration  Not applicable.
SN  - 1471-2393
ER  -