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 laparo
scopic 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.