Hysteroscopy Versus Laparoscopy in the Management of Isthmocele: A Review of the Literature

Abstract

Objective
Isthmocele is a pouch defect of the anterior uterine wall, detected at the site of the previous cesarean scar. It can be asymptomatic
or cause abnormal uterine bleeding, pelvic discomfort and difficulty conceiving. The main objective of this review is to highlight
the hysteroscopic and laparoscopic approaches in the management of this disorder.
Main Findings
During the hysteroscopic approach, the superior and inferior edges or just the superior edge of the defect are resected, removing
the fibrotic tissue and allowing renewal of the continuous canal between the cervix and the uterine cavity. Whereas, the laparoscopic approach consists of direct visualization and removal of the defect followed by re-approximation of the myometrium. Both
methods lead to significant improvement in symptoms and fertility.
Conclusion
While hysteroscopy is a quick non-morbid procedure that allows concurrent removal of other uterine pathology, laparoscopy is
characterized by improved visualization and decreased risk of complications with defects less than 3
mm as well as the possible correction of uterine retroversion. Definitely, randomized controlled trials are required in this field for
better guidance of the diagnosis and management