The value of hysteroscopic resection of "Isthmocele" in treating menstrual Disorders

Background: Isthmocele, a defect in the uterine wall at the location of a prior cesarean section, is increasingly recognized as an etiology of postmenstrual spotting, abnormal uterine bleeding (AUB), and pelvic discomfort. Hysteroscopic resection has emerged as a minimally invasive and effective treatment approach, though optimal surgical technique remains under evaluation. Objective: To evaluate and compare the efficiency of two hysteroscopic resection techniques—lower edge resection alone versus combined upper and lower edge resection—in decreasing AUB and postmenstrual spotting in females with symptomatic isthmocele. Methods: This interventional study included 60 women with diagnosed isthmocele, divided into two equal groups. Group A underwent hysteroscopic resection of the lower edge, while Group B underwent resection of both edges. Outcomes were measured in terms of reduction in bleeding days and residual niche depth via transvaginal ultrasound. Results: Both groups demonstrated a significant decrease in bleeding days and niche depth postoperatively (p-value below 0.001). There was no significant variance in postoperative bleeding among groups; however, Group A showed a significantly greater reduction in niche depth compared to Group B (1.48 ± 0.45 millimeters vs. 1.99 ± 0.49 millimeters, p-value equal to 0.001). Conclusion: Hysteroscopic resection of isthmocele is effective in relieving AUB and postmenstrual spotting. Lower edge resection alone may offer comparable symptom relief with a greater reduction in niche depth, suggesting it as a sufficient and potentially preferred technique.