Vaginal repair as salvage therapy benefits women with cesarean scar defects after failed repair surgery: a retrospective cohort study

Objective: To evaluate the clinical efficacy of vaginal repair as a salvage treatment for cesarean scar defects in patients with previously failed repair surgery. Methods: This retrospective cohort study included 16 patients with cesarean scar defects who underwent vaginal repair as salvage therapy after prior repair surgery failure between March 2019 and September 2022 at the Department of Obstetrics and Gynecology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. The previous failed procedures included vaginal repair, hysteroscopic repair, and laparoscopic repair. A control group of 108 patients who underwent primary vaginal repair during the same period was also analyzed. Perioperative outcomes and post-operative repair efficacy were compared. The length, width, and depth of the cesarean scar defect, as well as the thickness of the residual myometrium, were measured by transvaginal ultrasonography. Results: No significant differences were observed between the two groups in demographic characteristics. In both groups, the duration of menstruation significantly decreased after vaginal repair (from 12.8 ± 5.3 to 6.75 ± 1.8 days in the salvage therapy group, and from 13.5 ± 3.8 to 7.1 ± 1.7 days in the primary surgery group), while the thickness of the residual myometrium significantly increased (from 3.0 ± 2.0 to 7.7 ± 2.6 mm in the salvage therapy group, and from 2.6 ± 1.2 to 7.7 ± 2.5 mm in the primary surgery group). Post-operatively, there were no significant differences between the two groups in either menstrual duration (6.8 ± 1.8 vs . 7.1 ± 1.7 days) or residual myometrial thickness (7.7 ± 2.6 vs . 7.7 ± 2.5 mm). The data also indicated that performing salvage therapy within ≤21 months of the initial surgery was associated with a better prognosis. Conclusions: Vaginal repair as salvage therapy is a feasible and effective option for patients with cesarean scar defects after failed repair surgery.