Comparative Study Of Vaginal Versus Laparoscopic Approach In Surgery Treatment With Previous Cesarean Scar Defect

Objective The aim of this study was to explore the differences between vaginal surgery and laparoscopic surgery in patients with cesarean scar defect,analyze the factors affecting the efficacy of scar healing after surgery,provide new ideas for the selection and improvement of clinical CSD treatment.Methods A retrospective cohort analysis was performed on women who underwent 1 vaginal surgery and laparoscopic surgery for CSD from June 2015 to June 2021 in the Department of Gynecology of Wenzhou People’s Hospital.Among these participants,46 underwent vaginal surgery and 37 received laparoscopic surgery.The general condition,symptoms,uterine position,anemia,various indicators of scar diverticulum under ultrasound,clinical observation indicators during operation,complications,postoperative menstrual recovery,postoperative scar healing under ultrasound,postoperative re-pregnancy and re-delivery were compared between the two groups.Logistic regression analysis was used to explore the influencing factors of scar healing after CSD repair.Results 1.No significant difference was observed in age,BMI,number of cesarean sections,interval between the last cesarean section and this repair,menstrual period,uterine position,incidence of preoperative anemia,thickness of residual muscle layer of scar diverticulum,length(L),width(W)and depth(D)of diverticulum under ultrasound(P>0.05).2.Compared with the laparoscopic group,the vaginal group had less intraoperative blood loss,shorter operation time,and lower cost(P<0.05);No significant difference was observed in the length of hospital stay and the incidence of complications between the two groups(P>0.05).3.In the vaginal group,the cure rate of menstruation was 45.6%,the improvement rate was 45.6%,and the effective rate was 91.3%.In the laparoscopic group,the cure rate of menstruation was 51.4%,the improvement rate was 32.4%,and the effective rate was 83.8%,with no significant differences(P>0.05).Significant differences were displayed in TRM,L,W and D of the two groups after operation,(P<0.05).The scar recovery rate was 45.7%,the improvement rate was 50%,and the effective rate was 95.7%in the vaginal group,and 54.1%,the improvement rate was 32.4%,and the effective rate was 86.5%in the laparoscopic group.No significant difference was observed between the two groups(P>0.05).4.In the vaginal group,there were 25 patients with reproductive requirements,among which 5 patients were pregnant again,and 4 patients underwent cesarean section at full term pregnancy,and the process was safety without uterine rupture;There were 15 patients in the laparoscopic group who wanted to have another pregnancy,but no patients were followed up.There was no significant difference in the rate of re-birth and re-delivery between the two groups(P>0.05).5.Single factor and logistic regression analysis showed that intraoperative hysteroscopy assisted positioning of scar position was a protective factor for scar healing after repair,with OR 0.267(95%CI:0.094-0.754,P<0.05).Conclusion 1.Both vaginal and laparoscopic surgery were effective in the improvement of symptoms and scar healing of CSD patients,had few complications,and were safety methods。2.Compared with laparoscopic surgery,vaginal surgery has shorter operation time,less bleeding and lower cost,while the length of hospital stay and the incidence of complications are similar.3.Hysteroscopy was assistive used in vaginal and laparoscopic surgery of CSD can significantly improve the healing of scar.