A comparison between laparoscopy and hysteroscopy approaches in the treatment of symptomatic isthmocele: A systematic review and meta-analysis

Zahra Ramezani; Saba Goodarzi; Pegah Rashidian; Shima Mohammadian; Hadis Rastad; Mona Esmi; Arman Shafiee; Mahmood Bakhtiyari

doi:10.1016/j.eurox.2025.100405

A comparison between laparoscopy and hysteroscopy approaches in the treatment of symptomatic isthmocele: A systematic review and meta-analysis

Eur J Obstet Gynecol Reprod Biol X. 2025 Jun 4:27:100405. doi: 10.1016/j.eurox.2025.100405. eCollection 2025 Sep.

Authors

Zahra Ramezani¹, Saba Goodarzi², Pegah Rashidian³, Shima Mohammadian⁴, Hadis Rastad⁵, Mona Esmi⁴, Arman Shafiee^{1

2}, Mahmood Bakhtiyari¹

Affiliations

¹ Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
² Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
³ School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
⁴ Gynecology Oncology Department, Kamali Teaching Hospital, Alborz University of Medical Sciences, Karaj, Iran.
⁵ Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran.

Abstract

Objective: To compare the clinical outcomes of laparoscopy and hysteroscopy in the treatment of symptomatic isthmocele using a systematic review and meta-analysis.

Methods: A comprehensive search of PubMed, Scopus, and Web of Science was performed until November 11, 2024. Studies evaluating outcomes of laparoscopy or hysteroscopy intervention for treating symptomatic isthmocele were included in this study. A random-effects model was employed for heterogeneous data. The study is registered in PROSPERO with registration number CRD420251028603.

Results: Nine studies involving 797 patients were included. Hysteroscopy demonstrated significantly less intraoperative blood loss (SMD: -2.28, 95 % CI: -3.65 to -0.90) and shorter hospital stays (SMD: -2.62, 95 % CI: -3.52 to -1.72), but the operative time difference was non-significant. Both approaches were equally effective in symptom resolution and defect repair (OR: 0.80, 95 % CI: 0.21-2.97). However, laparoscopic repair was associated with better outcomes for dysmenorrhea improvement (OR: 3.46, 95 % CI: 1.42-8.45) and higher postoperative pregnancy rates (OR: 4.17, 95 % CI: 1.89-9.09). High heterogeneity was noted in some outcomes, reflecting variability in study designs and populations.

Conclusions: Both laparoscopy and hysteroscopy are effective in treating symptomatic isthmocele, with each approach offering distinct advantages. Hysteroscopy is less invasive with faster recovery and better fertility.

Keywords: Cesarean Scar Defect; Hysteroscopy; Isthmocele; Laparoscopy.

Publication types

Review