OBJECTIVE: To study the impact of laparoscopic niche repair on subendometrial peristalsis in women with a large niche. METHODS: A explorative prospective cohort study that included women with a large niche (residual myometrium ≤ 3 mm), actual wish to conceive who were scheduled for laparoscopic niche repair. To analyse the effect of a laparoscopic niche repair on the uterine anatomy and subendometrial peristalsis, all participants underwent a 4-5 min transvaginal ultrasound before surgery and three months post-surgery during the mid-luteal phase of the menstrual cycle. Subendometrial peristalsis was evaluated by strain analysis using a dedicated two-dimensional optical flow speckle tracking method. The following features were extracted from the strain signals: frequency, amplitude, velocity, coordination and direction of coordination. RESULTS: Post-surgery, the mean niche volume significantly decreased, with a mean reduction of 963.9 mm CONCLUSION: Subendometrial peristalsis is disturbed in women with a large niche. Individual contraction parameters such as velocity, amplitude and frequency decreased following laparoscopic niche repair which might be favourable for fertility purposes. These changes were associated with a reduction in niche volume and enlargement of the residual myometrium and warrant further validation in a larger cohort study.