To compare the therapeutic effects of three surgical approaches for cesarean scar diverticulum (CSD).

From January 2013 to January 2018, 80 patients diagnosed with CSD by transvaginal ultrasound at the First Affiliated Hospital of Zhejiang University were selected and divided into three groups: 40 patients who underwent hysteroscopic electrical incision of the diverticulum (hysteroscopic group), 30 patients who were treated by hysteroscopic-laparoscopic diverticulum repair (hysteroscopic-laparoscopic group), and 10 patients who underwent transvaginal repair of CSD (transvaginal group). For age, frequency of cesarean section, preoperative menstrual period, operative time, intraoperative bleeding, postoperative hospital stay, hospitalization expenses, and other indicators of the three groups, ANOVA was used for comparison among multiple groups, and LSD method was used for pairwise comparison. The efficacy and recurrence in the three groups within 12 months of follow-up were evaluated by the Chi-square test, pairwise comparison was performed by Chi-square segmentation, and they were finally corrected by the BONFERRONI method.

The operative time, intraoperative blood loss, postoperative hospital stay, and hospitalization cost of the hysteroscopic group were significantly less than those of the hysteroscopic-laparoscopic group and the transvaginal group (F=198.300, P<0.001; F=19.610, P<0.001; F=29.450, P<0.001; F=342.880, P<0.001), but there was no significant difference in age, frequency of cesarean section, or preoperative menstrual period among the three groups (P>0.05). In addition, there was no statistically significant difference in the efficacy or recurrence among the three groups within 12 months of follow-up (P>0.05).

All the three surgical methods have good effectiveness in the treatment of CSD, and hysteroscopic electrical incision of the diverticulum has higher clinical application value.

Scar diverticulum; Cesarean scar diverticulum; Surgery