Abstract: Objective To compare the clinical effects of hysteroscopy combined with vaginal surgery and hysteroscopy combined with laparoscopy in the treatment of cesarean section scar diverticulums, and explore the best method for cesarean section scar diverticulums. Methods Total 62 cases of cesarean section scar diverticulums confirmed by transvaginal sonography, with prolonged menstrual periods after the caesarean, were treated in our hospital between February, 2012 and September, 2015. The patients were divided into two groups according to the operation. Thirty-three patients in group A received hysteroscopy combined with vaginal surgery, while 29 patients in group B received hysteroscopy combined with laparoscopy surgery. There were no significant difference in the age and pregnant times. The operative time, hospitalization cost, intraoperative blood loss and postoperative vaginal bleeding time and hospitalization time were analyzed. Results In group A and B, there were significant difference in the operative time[(42.9±15.7)min vs. (60.5±12.5)min], hospitalization cost[(5 962±538.4)yuan vs. (12 013.4±680.2)yuan], intraoperative blood loss[(24.9±16.0) ml vs. (35.1±17.8) ml] and postoperative vaginal bleeding time[(9.6±3.6)days vs. 8.0±2.2)days], all P<0.05. There were no significant different between the two groups in the hospitalization time[(8.7±1.3) days vs. (9.08±1.08) days], amelioration of postoperative menstrual cycle (93.94% vs 93.1%), postoperative secondary pregnancy rate (66.67% vs. 71.43%) and postoperative recurrence rate (11.11% vs. 9.5%), P>0.05. Conclusion Both hysteroscopy combined with vaginal surgery and hysteroscopy combined with laparoscopy are suitable for Cesarean section scar diverticulums, however, transvaginal operation might be recommended for its short operation time, low hospitalization cost and less trauma, though the surgical field of transvaginal operation is narrow and surgical skills of the surgeon must be sophisticated.