The role of cesarean section surgical techniques in the prevention of isthmocele formation: retrospective cohort study

Compared to the traditional locking technique, the locking, double-layer, endometrium-sparing uterine closure method, in which the first layer of the uterine incision is continuously sutured without locking and the second layer is reinforced with a continuous 'U'-shaped suture, results in a statistically significant reduction in isthmocele formation, increased residual myometrial thickness, shorter operative time, and fewer niche-related symptoms. This method appears to improve short-term uterine healing and niche-related symptoms; however, its impact on future reproductive and obstetric outcomes remains unknown and requires prospective validation. However, multicenter studies with extended follow-up periods are warranted to confirm these findings.