Hysteroscopic vs. laparoscopic management of cesarian scar defect: a meta-analysis

Background The prevalence of cesarian scar defects (CSD) is increasing worldwide mainly due to the increasing rates of cesarian deliveries (CD). While hysteroscopic (H) and laparoscopic (L) are both popular approaches in the management of CSD, the superiority of one over the other remains debated. Therefore, this meta-analysis will compare H and L approaches for CSD treatment. Methods PubMed, Cochrane, and Google Scholar were queried through May 2026. Inclusion criteria consisted of studies comparing the outcomes of CSD management between H and L approaches. Extracted data included adverse events (overall complications, chronic pelvic pain, abnormal bleeding, dyspareunia, dysmenorrhea), CSD parameters (change in isthmocele depth, change in residual myometrial thickness (RMT)), surgical parameters (operative time, estimated blood loss (EBL), length of stay (LOS), and cost), and pregnancy outcomes among patients desiring pregnancy (subsequent pregnancies, abortions, premature deliveries, and term deliveries). Results Ten studies met the inclusion criteria including 798 patients, with 361 being in the H group and 437 in the L group. Patients in the H group had a lower rate of overall complications (Odds-Ratio = 0.24, p = 0.02), shorter operative time (Mean difference= -55.94 min, p <0.001), less EBL (Mean difference= -37.73 ml; p <0.001), shorter LOS (Mean difference= -2.84 days; p <0.001), and less costs (Mean difference= $-1310; p <0.001). However, the H group also had less change in RMT compared to the L group (Mean difference= -2.60 mm; p = 0.0007). There were no differences in the remaining outcomes. Conclusion Patients undergoing hysteroscopic management of CSD had shorter operative time, shorter length of stay, less blood loss, less costs, and less complications. However, they also had less improvement in RMT. Nevertheless, both techniques did not differ in post-operative symptoms, adverse events, or pregnancy-related outcomes, making them both a viable option for the management of CSD. Trial registration Not applicable.