Abstract
BACKGROUND: Cesarean scar defect (CSD) is characterized by localized thinning of the myometrium due to defective healing of a previous cesarean section incision. It is frequently associated with abnormal uterine bleeding (AUB) and secondary infertility, and high-quality evidence regarding its surgical management is lacking. As a novel reconstructive technique, the efficacy of laparoscopic CSD folding suture in alleviating AUB and improving fertility outcomes remains to be validated. PURPOSE: In the absence of high-quality evidence, this study aimed to provide preliminary evidence on the efficacy of laparoscopic folding suture in relieving AUB-related symptoms (assessed by menstrual duration) and optimizing reproductive outcomes, and to assess its feasibility and safety. PATIENTS AND METHODS: This single-centre, retrospective case series included patients who underwent laparoscopic folding suture for CSD at Shandong Provincial Maternal and Child Health Hospital between October 2021 and March 2025. A total of 36 patients were assessed for eligibility; 10 were excluded for the following reasons: lost to follow-up within 3 months postoperatively (n = 3), prior hysteroscopic repair of CSD (n = 2), concurrent endometrial polyps (n = 3), and confirmed tubal factor infertility (n = 2). The remaining 26 women were included in the final analysis. The primary endpoint was change in menstrual duration before and after surgery; secondary endpoints comprised subsequent pregnancy outcomes, change in residual myometrial thickness (RMT), and perioperative adverse events. RESULTS: Menstrual duration was shortened in 96.2% of patients (25/26), with the median menstrual duration significantly decreasing from 14.5 days (IQR 10.0-15.0) preoperatively to 7.0 days (IQR 6.0-9.0) postoperatively (P < 0.001). Sixteen (61.5%) were actively trying to conceive; during follow-up, 12 of these individuals (75%) achieved pregnancy. Intraoperative blood loss was 30 mL (IQR 20-50). The RMT increased significantly from 1.3 mm (IQR 1.0-1.7) preoperatively to 6.5 mm (IQR 5.0-7.0) postoperatively (median increase 5.2 mm; P < 0.001). CONCLUSION: This single-centre retrospective case series suggests that laparoscopic folding suture is a safe and feasible technique for CSD repair, associated with significant improvement in menstrual symptoms and favorable pregnancy outcomes. However, due to the study design, these preliminary findings warrant confirmation in larger, prospective controlled trials.