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Study Objective: Compare the efficacy and the safety between vaginal surgery and operative hysteroscopy in the treatment of cesarean-induced isthmocele Design: Retrospective record review Design Classification: Ⅱ-2 Setting: Department of Gynecology.First Affiliated Hospital of Sun Yat-sen University, Second Affiliated Hospital of Sun Yat-sen University; Guangzhou, China Patients: Seventy-seven women with cesarean-induced isthmocele Interventions: Vaginal surgery and operative hysteroscopy Measurements: Treatment efficacy Results: Operative efficacy of the vaginal surgery was superior to the operative hysteroscopy(93.5% vs.64.5%, p <0.001), However, patients who underwent the vaginal surgery had longer operating times (55 min vs.25 rnin, p < 0.001) and more blood loss (50 mL vs.10 mL,36p < 0.001) than whom underwent operative hysteroscopy.Two in each group got pregnancy post-operation.There was a correlation between the existence of a residual nidus and the length of menstrual periods after surgery, patients who had menstrual periods longer than seven days were more likely to have a residual nidus.Conclusions: The therapeutic efficacy of vaginal surgery is superior to operative hysteroscopy in the treatment of cesarean-induced isthmocele, even there is difference in operation time and blood loss during the procedure, for there is no special operating equipment requirements, vaginal surgery can be extensively employed, particularly in underdeveloped communities.