A Comparison of Vaginal Surgery and Operative Hysteroscopy for the Treatment of Cesarean-Induced Isthmocele: A Retrospective Review

Abstract

Background/Aims: Cesarean-induced isthmocele can cause heavy or prolonged menses, dyspareunia, and dysmenorrhea. We compared the efficacy of vaginal surgery and operative hysteroscopy for the treatment of cesarean-induced isthmocele. Methods: Seventy-seven women with cesarean-induced isthmocele underwent either vaginal surgery or operative hysteroscopy between August 2008 and December 2011. We evaluated operating time, blood loss, complications, and postoperative pregnancy. Operative efficacy was defined as an improvement in menstrual periods and a change in residual isthmocele nidus size on transvaginal ultrasonography. Results: The operative efficacy of vaginal surgery was superior to that of hysteroscopy (93.5 vs. 64.5%; p < 0.001). However, patients who underwent vaginal surgery had a longer operative time (55 vs. 25 min; p < 0.001) and greater blood loss (50 vs. 10 ml; p < 0.001). Two patients in each group were able to achieve subsequent pregnancy. Patients who had menstrual periods longer than 7 days after surgery were more likely to have a residual nidus. Conclusions: The therapeutic efficacy of vaginal surgery is superior to operative hysteroscopy in the treatment of cesarean-induced isthmocele.