Era-specific interrupted and continuous barbed-suture myometrial closure for laparoscopic cesarean scar defect repair: A historical cohort study

To compare 3-month postoperative residual myometrial thickness (RMT) and symptoms between two era-specific closure strategies for laparoscopic cesarean scar defect (CSD) repair, and to describe subsequent pregnancy outcomes.

This retrospective historical cohort included 63 patients undergoing laparoscopic CSD repair from March 2021 to August 2025. Two-layer closure was performed in both the earlier-period interrupted closure group (EP group; n = 27) and the later-period continuous barbed-suture closure group (LP group; n = 36). The principal analysis compared 3-month postoperative RMT after adjustment for preoperative RMT. Changes in dysmenorrhea NRS and bleeding duration were secondary outcomes. Pregnancy within 18 months was exploratory among patients desiring pregnancy with at least 18 months of follow-up.

In the principal baseline-adjusted analysis, 3-month postoperative RMT was 2.48 mm greater in the EP group than in the LP group (95 % CI, 1.26-3.69; P < 0.001). Sensitivity analyses yielded smaller point estimates in the same direction. The reduction in dysmenorrhea NRS was greater in the EP group [median change, -3 (IQR, -6 to - 2) vs - 2 (-4 to 0); P = 0.017], whereas the change in bleeding duration did not differ significantly between groups (P = 0.141). Pregnancy within 18 months occurred in 13/20 (65.0 %) and 10/15 (66.7 %) eligible patients, respectively; the small sample precluded meaningful between-group comparison.

Although residual confounding and concurrent changes in closure configuration, suture material/product, and treatment era preclude attribution to a specific component, the greater adjusted 3-month RMT observed in the EP group provides a hypothesis-generating anatomical signal that warrants prospective evaluation.