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- Title
Comparison of laparoscopic and hysteroscopic surgical treatments for isthmocele: A prospective cohort.
- Authors
Hosseini, Reyhane; Parsaei, Mohammadamin; Ali-abad, Nahid Rezaei; Daliri, Sepand; Asgari, Zahra; Valian, Zahra; Hajiloo, Nasrin; Mirzaei, Samira; Bakhshali-bakhtiari, Mina
- Abstract
Objective: To evaluate the clinical outcomes of laparoscopic and hysteroscopic surgical approaches for treating symptomatic isthmocele and identify their associated factors. Materials and Methods: Forty-six patients with symptomatic isthmocele diagnosed using transvaginal saline infusion sonohysterography were enrolled in this prospective cohort study. Patients underwent either laparoscopic or hysteroscopic isthmoplasty based on their residual myometrial thicknesses and fertility desires and were subsequently followed by clinical and ultrasonographic examinations. Results: Twenty-two patients underwent laparoscopy and 24 underwent hysteroscopic surgery. At baseline, there was no significant difference in the mean age and years since the last cesarean section between the two groups. However, the hysteroscopy group had a higher mean parity and previous cesarean sections (p=0.00, 0.03). The most common symptoms were abnormal uterine bleeding, infertility, and dysmenorrhea. The mean baseline residual myometrial thickness was significantly higher in the laparoscopy group (p=0.00), and only laparoscopic surgery led to a significant increase in residual myometrial thickness in patients (p=0.00). Both procedures significantly reduced abnormal uterine bleeding (p=0.00), but only laparoscopy reduced infertility (p=0.00) and hysteroscopy reduced dysmenorrhea (p=0.03). Hysteroscopy showed better symptom resolution in younger patients (p=0.01), whereas age did not affect laparoscopy outcomes. Conclusion: Both approaches showed similar effectiveness in resolving abnormal uterine bleeding, with laparoscopy excelling in infertility resolution and hysteroscopy excelling in dysmenorrhea resolution.
- Subjects
IRAN; CESAREAN section; METRORRHAGIA; T-test (Statistics); DATA analysis; SURGERY; PATIENTS; RECEIVER operating characteristic curves; LAPAROSCOPIC surgery; INTERVIEWING; FISHER exact test; LOGISTIC regression analysis; INFERTILITY; MYOMETRIUM; SCIENTIFIC observation; SCARS; TREATMENT effectiveness; AGE distribution; HOSPITALS; CHI-squared test; DESCRIPTIVE statistics; SURGICAL complications; LONGITUDINAL method; UTERINE diseases; MEDICAL records; ACQUISITION of data; STATISTICS; COMPARATIVE studies; DATA analysis software; CONFIDENCE intervals; DYSMENORRHEA; HYSTEROSCOPY; SYMPTOMS
- Publication
Turkish Journal of Obstetrics & Gynecology, 2024, Vol 21, Issue 2, p70
- ISSN
2149-9322
- Publication type
Article
- DOI
10.4274/tjod.galenos.2024.54006