Abstract: Objective To compare the effect of transvaginal versus hysteroscopic resection on patients with cesarean scar diverticulum (CSD). Methods Sixty-five cases with CSD treated in Chinese PLA General Hospital from January 2013 to January 2017 were selected and divided into two groups according to the operation methods. The study group underwent transvaginal CSD resection, while the control group underwent hysteroscopic combined with laparoscopic CSD resection. Baseline data and clinical outcomes were recorded and compared between the two groups. Results There was no significant difference between the two groups in age, the history of cesarean section, the length of vaginal bleeding per month, and the thickness of myometrium in the uterus defect (All P > 0.05). The operating time (74.3±22.5) min vs (103.5±36.4) min, the amount of bleeding (54.0±28.2) ml vs(78.6±25.9) ml and the hospitalization expenses (7 968.3±897.6) yuan vs (13 478.4±1 743.5) yuan of the study group were shorter or less than those of the control group with statistically significant differences (All P< 0.05). After 1 month of follow-up, the effective rate of the study group was 74.2%, which was higher than that of the control group (58.8%) without significant difference(P> 0.05). After 6 months of follow-up, the effective rate of the study group was 87.1%, higher than 67.6% of the control group, and the difference was statistically significant (P< 0.05). Conclusion The clinical efficacy of transvaginal CSD resection is superior to hysteroscopic combined with laparoscopic surgery with shorter operating time, less amount of bleeding and hospitalization expenses, which has important clinical value.