Symptomatic isthmocele after cesarean section: hysteroscopic versus laparoscopic repair – a systematic review

Introduction: Isthmocele is a cesarean scar defect associated with abnormal uterine bleeding, pelvic pain and secondary infertility. Objective: To compare hysteroscopic and laparoscopic repair of symptomatic isthmocele. Methods: Systematic review (PRISMA 2020) in PubMed and SciELO, 2015–2026, using DeCS/MeSH descriptors and Boolean operators; qualitative synthesis. Results: Of 356 records, nine studies were included. Both approaches improved symptoms in 84% to 93% of patients in meta-analyses. Hysteroscopy showed shorter operative time, lower blood loss, shorter hospital stay and fewer complications, but did not increase residual myometrium. Laparoscopy increased residual myometrium to 6.7–9.6 mm and was associated with a 62% clinical pregnancy rate in infertile women. Conclusion: Hysteroscopy is preferred for defects with residual myometrium ≥ 2.5–3 mm; laparoscopy is preferable for thin defects and for women desiring pregnancy. (AU)