Using laparoscopy and hysteroscopy to treat cesarean scar defects: A systematic review and meta-analysis

Abstract

Objective: Rising cesarean section rates have led to an increase in cesarean scar defects. However, there is no consensus regarding the gold standard for treating cesarean scar defects. This study aims to compare the efficacy of laparoscopy combined with hysteroscopy and hysteroscopy in treating cesarean scar defects. Methods: An electronic search of the MEDLINE, EMBASE, and Clinical Trials.gov databases was conducted in May 2020, utilizing combinations of relevant medical subject headings for “cesarean scar defect”, “laparoscope”, and “hysteroscope”. Reference lists of relevant articles and reviews were hand-searched for additional reports. Observed outcomes included menstruation after surgery, blood loss, operative time, and further fertility. Results: Eight studies with 467 patients were included. The menstruation duration after surgery for the laparoscopy combined with hysteroscopy group and hysteroscopy group was comparable. While the laparoscopy combined with hysteroscopy group trended to have less blood loss (mean difference 49.60, 95% CI: 42.12–57.09, p < 0.05) and shorter operative time (mean difference 60.40, 95% CI: 53.33–67.48, p < 0.05) compared to hysteroscopy group. And 26 out of 51 patients were able to achieve pregnancy for those choosing the laparoscopy combined with hysteroscopy. Conclusions: Patients with cesarean scar defect should choose the appropriate technique considering their age, residual myometrial thickness, desire for further fertility, and gynecological inflammation. The current study lacked evidence to prove that laparoscopy combined with hysteroscopy is superior to hysteroscopy.

Keywords

• Laparoscopy
• Hysteroscopy
• Cesarean scar defect