Clinical and Reproductive Outcomes After Hysteroscopic Repair of Isthmocele

Abstract

OBJECTIVE: The growing global prevalence of cesarean delivery has increased the incidence of long-term scar complications, among which isthmocele represents a clinically relevant yet often under-recognized entity. This defect, characterized by incomplete myometrial healing at the cesarean incision site, has been associated with abnormal uterine bleeding, pelvic pain, and secondary infertility. Although hysteroscopic correction has emerged as a minimally invasive treatment option, data on its long-term clinical and reproductive outcomes remain limited.

STUDY DESIGN: This multicenter retrospective cohort included 96 women diagnosed with isthmocele who underwent hysteroscopic repair across three hospitals in Turkey. Demographic, hematologic, and surgical data were extracted from institutional records. Primary outcomes were symptom resolution, fertility outcomes, complications, and reoperation rates; secondary measures included operative time, hospital stay, and perioperative morbidity.

RESULTS: The mean patient age was 34.7 years. Preoperative mean hemoglobin was 11.6 g/dL and ferritin 81.4 ng/mL. Complete symptom resolution was achieved in 69.8% of patients, and 25.0% of the total cohort conceived post-surgery. However, this proportion could not be restricted to women who had expressed a desire for pregnancy (see Limitations). The reoperation rate was 36.5%. A mean interval of 3.56 years was recorded among patients with persistent or recurrent symptoms, although these two groups could not be distinguished in this retrospective dataset (see Limitations). No major intraoperative or postoperative complications were observed, and minor complications occurred in 3.1% of cases.

CONCLUSION: Hysteroscopic repair of isthmocele was associated with substantial symptomatic improvement and a low complication profile. Fertility outcomes require cautious interpretation given limitations in linking pregnancy intention to conception at the patient level. Individualized patient selection - informed by residual myometrial thickness where available and by reproductive goals - appears important, although this retrospective, single-arm design cannot directly test that recommendation.