Hysteroscopy with vaginal repair best surgical approach for caesarean scar defects

In treating caesarean scar defects (CSD), the combination of hysteroscopy with vaginal repair appears to have the best clinical value, leading to the highest clinical efficacy while also conferring low risks of postoperative complications, reports a recent network meta-analysis.

A total of 31 randomized controlled trials, totaling 2,269 patients, were included in the quantitative synthesis. Six surgical procedures were evaluated: laparoscopy, hysteroscopy, and vaginal repair, as well as the combinations between laparoscopy and hysteroscopy (LH), hysteroscopy and vaginal repair (HV), and laparoscopy with vaginal repair (LV).

The surgical approaches were then ranked based on the surface under the cumulative ranking curve for procedural, clinical, and economic outcomes.

Of all the procedures assessed, HV emerged as the best surgical approach to CSD, outranking all other procedures in terms of clinical efficacy, menses recovery, diverticulum recovery, postoperative complications, and length of stay in the hospital. Hysterectomy alone ranked first in the remaining three outcome measures: operating time, blood loss, and hospitalization costs.

In contrast, laparoscopy alone might be the worst option, ranking last in terms of hospitalization length and clinical efficacy. Laparoscopy also performed poorly when assessed according to operating time and blood loss.

“To our knowledge, the current systematic review is the first network meta-analysis that compares the six different surgical methods for the treatment of CSD,” the researchers said.