Laparoscopy vs. Laparotomy for Management of Postpartum Complications—A Retrospective Cohort Study

<b>Background:</b> Postpartum complications requiring surgical intervention are challenging due to physiologic and anatomic changes. While laparotomy remains standard, laparoscopy is increasingly used. We compared outcomes of laparoscopic management of postpartum complications versus open management of postpartum complications. <b>Methods:</b> This retrospective cohort study included patients undergoing surgical intervention within three weeks postpartum at a single tertiary center between 2010 and 2023. Approach selection was primarily time-dependent, following an institutional practice change in 2020. Demographic, operative, and postoperative outcomes were compared. <b>Results:</b> Sixty-two participants with postpartum complications necessitating surgical intervention were included: 54 in the laparotomy group and 8 who underwent laparoscopy. Demographic characteristics were similar between groups. The main indication for laparoscopy was suspected uterine scar defects (<i>p</i> = 0.006), while laparotomy was obtained mainly in cases of suspected bleeding (<i>p</i> = 0.001). Both groups had comparable operative time, though the laparoscopy group had a shorter postoperative admission (<i>p</i> = 0.043). <b>Conclusions:</b> Laparoscopy is feasible for various postpartum complications. It offers comparable operative times to laparotomy with shorter postoperative admissions. Therefore, it is a promising alternative in selected cases when surgical expertise is available.