Hysteroscopy with Vaginal Repair Best Surgical Approach for Cesarean Scar Defects | Latest news for doctors, nurses and pharmacists

In the treatment of caesarean section (CSD) scarring defects, the combination of hysteroscopy with vaginal repair appears to have the best clinical value, leading to the greatest clinical efficacy while also conferring low risks of postoperative complications, reports a recent network meta-analysis.

A total of 31 randomized controlled trials, involving 2269 patients, were included in the quantitative synthesis. Six surgical procedures were evaluated: laparoscopy, hysteroscopy and vaginal repair, as well as combinations of laparoscopy and hysteroscopy (LH), hysteroscopy and vaginal repair (HV) and laparoscopy with vaginal repair (LV).

Surgical approaches were then ranked based on area under the cumulative ranking curve for procedural, clinical, and economic outcomes.

Of all the procedures evaluated, HV emerged as the best surgical approach to CSD, outperforming all other procedures in terms of clinical effectiveness, menstruation recovery, diverticula recovery, postoperative complications, and length of stay to the hospital. Hysterectomy alone ranked first in the remaining three outcome measures: operation time, blood loss, and hospitalization costs.

In contrast, laparoscopy alone might be the worst option, ranking last in terms of hospital stay and clinical effectiveness. Laparoscopy also performed poorly when assessed by operative time and blood loss.

“To our knowledge, the current systematic review is the first network meta-analysis that compares six different surgical methods for the treatment of CSD,” the researchers said.

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