A Comparative Study of Transvaginal Repair and Laparoscopic Repair in the Management of Patients With Previous Cesarean Scar Defect.

STUDY OBJECTIVE: The study objective was to compare transvaginal intervention and laparoscopic repair for correcting the uterine defect in patients with previous cesarean scar defect (PCSD).

DESIGN: Retrospective study (Canadian Task Force classification).

SETTING: Previous studies have reported that transvaginal surgery and laparoscopic surgery are available treatment options for patients with PCSD. However, the two methods have not been compared before.

PATIENTS: A total of 124 patients with PCSD were included in the retrospective study between December 2010 and December 2014.

INTERVENTIONS: In the study, 65 patients received transvaginal repair, and 59 patients received laparoscopic repair.

MEASUREMENTS AND MAIN RESULTS: Operation time, blood loss, hospital stay length and hospitalization expense, clinical syndromes and healing of uterine defect 3 months postoperatively were compared between the two surgical approaches. Patients receiving transvaginal repair exhibited significantly shorter operation time and lower hospitalization expenses than the patients receiving laparoscopic repair. Follow-up data showed that prolonged menstrual bleeding syndrome was obviously improved in 89% of patients undergoing transvaginal intervention and 86% of patients undergoing laparoscopic repair. The uterine defect disappeared or was substantially reduced in 87% of patients undergoing transvaginal intervention and 86% of patients undergoing laparoscopic repair. The differences between the two surgical approaches were insignificant.

CONCLUSION: Transvaginal repair is comparably effective to the laparoscopic repair and may be a more cost-effective and convenient surgical approach in the management of patients with PCSD.