Surgical Repair of Cesarean Scar Niche: A Comparative Study of Laparoscopy Versus Laparotomy

Objective: To compare the clinical efficacy and obstetric outcomes of transabdominal excision and repair of large cesarean section niches (CSN) with residual myometrial thickness (RMT) <3 mm, using either laparotomy or laparoscopy. Methods: Twenty symptomatic women presenting with postmenstrual spotting (PMS), dyspareunia, or infertility and confirmed large CSNs (depth >50% of myometrial thickness, RMT ≤3 mm via transvaginal ultrasound [TVU] and MRI) were enrolled. Participants were randomly assigned to undergo either laparotomy or laparoscopic repair. Postoperative evaluations were conducted at 1, 3, and 6 months using TVU and clinical assessment of symptom resolution. Results: All patients demonstrated niche resolution on TVU by one month. Myometrial thickness increased by approximately 175% in three months. By six months, dyspareunia was absent, PMS frequency dropped from 75% to 15%, and dysmenorrhea from 60% to 15%. No significant differences were observed in overall clinical effectiveness between the two groups. However, laparoscopy yielded lower postoperative pain scores, shorter hospital stays, and faster recovery, though operative time was longer. Conclusion: Transabdominal CSN repair is effective in improving gynecological symptoms and increasing myometrial thickness. While both surgical approaches were successful, laparoscopic repair offered superior postoperative recovery outcomes.