# Analysis of outcomes of laparotomic, laparoscopic, and hysteroscopic symptomatic ısthmocele (niche) repair in Turkish women

## TL;DR

This study compares surgical methods for repairing uterine isthmoceles in Turkish women, finding that hysteroscopy is faster but abdominal surgery may improve future pregnancy outcomes.

## Contribution

The study provides a larger sample size analysis of isthmocele repair outcomes in Turkish women, comparing laparotomic, laparoscopic, and hysteroscopic approaches.

## Key findings

- Hysteroscopic repair had shorter operative time and hospital stay compared to abdominal methods.
- Abdominal repair resulted in thicker myometrial healing and lower persistent isthmocele sac rates.
- 58.3% of patients who desired pregnancy conceived spontaneously after surgery.

## Abstract

Studies reporting the outcomes of patients after surgical repair of uterine isthmoceles usually have small patient populations. Therefore, the aim of the study was to contribute to the literature by reporting the outcomes of surgical repair of uterine isthmoceles in Turkish women.

This retrospective study included 41 patients who underwent surgical repair for symptomatic uterine isthmoceles. The patients were divided into two groups: those who underwent vaginal operative hysteroscopy and those who underwent abdominal laparoscopy and laparotomy.

Surgical repair was performed vaginally in 29 patients (70.7%) using operative hysteroscopy and abdominally (laparotomy and laparoscopy) in 12 patients (29.3%). The isthomocele sac size, mean operative time, and median hospital stay were significantly shorter in the hysteroscopically repaired group (p<0.01, p=0.03, and p<0.01, respectively). Six months after surgery, the rate of persistent isthmocele sac was higher in the hysteroscopically repaired group (p<0.01). The myometrial thickness in the area of the repaired isthmocele sac was thicker in the abdominally repaired group (p<0.01). Among the 12 patients who desired pregnancy and underwent surgical repair, 58.3% (n=7) conceived spontaneously. Of these pregnancies, 71.4% were intrauterine and 28.6% were cesarean scar.

Hysteroscopic repair of uterine isthmoceles is advantageous, as it contributes to a shorter operative time and shorter hospital stay. However, complete removal of the isthmocele sac via the abdominal route appears to be more beneficial in terms of live birth rates in future pregnancies. Therefore, we recommend laparoscopic or laparotomic isthmocele repair in patients with fertility desires.