European journal of obstetrics, gynecology, and reproductive biology · 2026
Clinical outcomes of novel vaginal repair versus laparoscopic resection in women with cesarean scar defect: A retrospective cohort study.
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Zhou Xiujing, Huang Lingxiao, Li Junli, Zhao Na, Chen Jingjing
Аннотация
OBJECTIVE: To evaluate the outcomes of novel vaginal repair compared with laparoscopic resection in women with cesarean scar defect (CSD).
DESIGN: Retrospective cohort study.
SETTING: Department of Obstetrics and Gynecology, Wenzhou People's Hospital, from January 2021 to December 2024.
PARTICIPANTS: We included 69 women with CSD in this study, with 31 receiving novel vaginal repair (novel) and 38 receiving laparoscopic resection (lap).
INTERVENTIONS: Participants underwent novel vaginal repair or laparoscopic resection.
MEASUREMENTS AND MAIN RESULTS: We assessed perioperative outcomes (operative time, intraoperative blood loss, hospital stay, hospitalization cost) and 6-month follow-up outcomes (clinical symptom improvement, uterine healing) in both surgical groups. Compared with the lap group, the novel group showed less intraoperative blood loss (median 20 mL vs 50 mL, P < 0.001), along with shorter hospital stay (median 5.81 days vs 7 days, P < 0.001), and lower hospitalization cost (median $1267 vs $2008, P < 0.001). Although the mean operative time tended to be shorter in the novel group, the difference did not reach statistical significance. At 6-month follow-up, residual myometrial thickness (RMT) increased significantly in both groups, with a greater increase in the novel group (mean + 3.82 ± 2.94 mm vs + 1.91 ± 1.87 mm, P = 0.003). Prolonged menstrual bleeding was alleviated in 93.6% of patients in the novel group and 84.2% in the lap group. Uterine defects were resolved or markedly reduced in 96.8% and 86.9%, respectively. Exploratory stratified analyses assessed the relationship between surgical technique and menstrual improvement. In the overall cohort, the adjusted odds ratio suggested a numerically higher likelihood of improvement in the novel group, though this did not reach statistical significance (aOR = 2.98, 95% CI 0.68-12.94, P = 0.15). A similar pattern was observed in patients with persistent CSD (aOR = 3.95, 95% CI 0.66-23.55, P = 0.14). In contrast, when CSD had completely resolved, outcomes did not appear to differ between groups (aOR = 0.91, 95% CI 0.12-7.05; P = 0.95).
CONCLUSION: Novel vaginal repair may represent a feasible and more economical alternative to laparoscopic resection for patients with CSD.
DESIGN: Retrospective cohort study.
SETTING: Department of Obstetrics and Gynecology, Wenzhou People's Hospital, from January 2021 to December 2024.
PARTICIPANTS: We included 69 women with CSD in this study, with 31 receiving novel vaginal repair (novel) and 38 receiving laparoscopic resection (lap).
INTERVENTIONS: Participants underwent novel vaginal repair or laparoscopic resection.
MEASUREMENTS AND MAIN RESULTS: We assessed perioperative outcomes (operative time, intraoperative blood loss, hospital stay, hospitalization cost) and 6-month follow-up outcomes (clinical symptom improvement, uterine healing) in both surgical groups. Compared with the lap group, the novel group showed less intraoperative blood loss (median 20 mL vs 50 mL, P < 0.001), along with shorter hospital stay (median 5.81 days vs 7 days, P < 0.001), and lower hospitalization cost (median $1267 vs $2008, P < 0.001). Although the mean operative time tended to be shorter in the novel group, the difference did not reach statistical significance. At 6-month follow-up, residual myometrial thickness (RMT) increased significantly in both groups, with a greater increase in the novel group (mean + 3.82 ± 2.94 mm vs + 1.91 ± 1.87 mm, P = 0.003). Prolonged menstrual bleeding was alleviated in 93.6% of patients in the novel group and 84.2% in the lap group. Uterine defects were resolved or markedly reduced in 96.8% and 86.9%, respectively. Exploratory stratified analyses assessed the relationship between surgical technique and menstrual improvement. In the overall cohort, the adjusted odds ratio suggested a numerically higher likelihood of improvement in the novel group, though this did not reach statistical significance (aOR = 2.98, 95% CI 0.68-12.94, P = 0.15). A similar pattern was observed in patients with persistent CSD (aOR = 3.95, 95% CI 0.66-23.55, P = 0.14). In contrast, when CSD had completely resolved, outcomes did not appear to differ between groups (aOR = 0.91, 95% CI 0.12-7.05; P = 0.95).
CONCLUSION: Novel vaginal repair may represent a feasible and more economical alternative to laparoscopic resection for patients with CSD.