E-ISSN: 2619-9467

Contents    Cover    Publication Date: 15 Dec 2023
Year 2023 - Volume 33 - Issue 4

Open Access

Peer Reviewed

ORIGINAL RESEARCH
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Comparison of the Effectiveness of Classical and Single-knot Fascia Closure Methods in Reducing Pain and Tenderness in the Incision Area After Cesarean Section: A Prospective Cohort Study

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JCOG. 2023;33(4):203-9
DOI: 10.5336/jcog.2023-98021
Article Language: EN
Copyright Ⓒ 2024 by Türkiye Klinikleri. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
Objective: We compared the effects of single-knot fascia closure technique and classical fascia closure technique on postoperative pain in fascia closure. Material and Methods: In this prospective cohort study, 80 term non-obese pregnant women who had no complicated pregnancy and no additional disease, and who were planned for elective cesarean section were included in the study. Classical fascia closure method was applied to one group (n=40) and single-knot fascia closure method was applied to the other group (n=40). In the singleknot fascia closure technique, the suture was threaded down from the upper part of the right fascia corner and the needle was removed from the lower part of the fascia upwards, approximately 0.5 cm behind the left fascia corner. In the classical fascia closure technique, the fascia was closed continuously. Pain was evaluated with visual analogue scale (VAS) at 8th, 24th hours, and 3rd months postoperatively. The cases were followed up for the development of infection, hematoma, seroma, and hernia at the wound site within 3 months postoperatively. Results: Wound infection, seroma, hematoma, and hernia did not develop in the postoperative period in both groups. However, VAS values at the 8th and 24th hours and 3rd months were significantly lower in the group in which the single knot fascia closure method was applied. Conclusion: The single-knot fascia closure method is an effective and reliable method in reducing postoperative pain after cesarean section.
REFERENCES:
  1. Berghella V, Baxter JK, Chauhan SP. Evidence-based surgery for cesarean delivery. Am J Obstet Gynecol. 2005;193(5):1607-17. [Crossref]  [PubMed] 
  2. ACOG Practice Bulletin No. 205: Vaginal Birth After Cesarean Delivery. Obstet Gynecol. 2019;133(2):e110-e127. [Crossref]  [PubMed] 
  3. Clapp MA, Barth WH. The future of cesarean delivery rates in the United States. Clin Obstet Gynecol. 2017;60(4):829-39. [Crossref]  [PubMed] 
  4. Dahlke JD, Mendez-Figueroa H, Rouse DJ, Berghella V, Baxter JK, Chauhan SP. Evidence-based surgery for cesarean delivery: an updated systematic review. Am J Obstet Gynecol. 2013;209(4):294-306. [Crossref]  [PubMed] 
  5. Walton RB, Shnaekel KL, Ounpraseuth ST, Napolitano PG, Magann EF. High transverse skin incisions may reduce wound complications in obese women having cesarean sections: a pilot study. J Matern Fetal Neonatal Med. 2019;32(5):781-5. [Crossref]  [PubMed] 
  6. Gamez BH, Habib AS. Predicting severity of acute pain after cesarean delivery: a narrative review. Anesth Analg. 2018;126(5):1606-14. [Crossref]  [PubMed] 
  7. Huang J, Cao C, Nelson G, Wilson RD. A review of enhanced recovery after surgery principles used for scheduled caesarean delivery. J Obstet Gynaecol Can. 2019;41(12):1775-88. [Crossref]  [PubMed] 
  8. Sun KW, Pan PH. Persistent pain after cesarean delivery. Int J Obstet Anesth. 2019;40:78-90. [Crossref]  [PubMed] 
  9. Eisenach JC, Pan PH, Smiley R, Lavand'homme P, Landau R, Houle TT. Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression. Pain. 2008;140(1):87-94. [Crossref]  [PubMed]  [PMC] 
  10. PROSPECT [Internet]. [Cited: November 04, 2020]. Recommendations for postoperative analgesia after caesarean section 2014. Available from: [Link] 
  11. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8. [Crossref]  [PubMed] 
  12. Gates S, Anderson ER. Wound drainage for caesarean section. Cochrane Database Syst Rev. 2013;(12):CD004549. [Crossref]  [PubMed] 
  13. Lyell DJ, Naqvi M, Wong A, Urban R, Carvalho B. Rectus muscle reapproximation at cesarean delivery and postoperative pain: a randomized controlled trial. Surg J (N Y). 2017;3(3):e128-e33. [Crossref]  [PubMed]  [PMC] 
  14. Fowler JR, Perkins TA, Buttaro BA, Truant AL. Bacteria adhere less to barbed monofilament than braided sutures in a contaminated wound model. Clin Orthop Relat Res. 2013;471(2):665-71. [Crossref]  [PubMed]  [PMC] 
  15. Patel SV, Paskar DD, Nelson RL, Vedula SS, Steele SR. Closure methods for laparotomy incisions for preventing incisional hernias and other wound complications. Cochrane Database Syst Rev. 2017;11(11):CD005661. [Crossref]  [PubMed]  [PMC] 
  16. Encarnacion B, Zlatnik MG. Cesarean delivery technique: evidence or tradition? A review of the evidence-based cesarean delivery. Obstet Gynecol Surv. 2012;67(8):483-94. [Crossref]  [PubMed] 
  17. Pergialiotis V, Prodromidou A, Perrea DN, Doumouchtsis SK. The impact of subcutaneous tissue suturing at caesarean section on wound complications: a meta-analysis. BJOG. 2017;124(7):1018-25. [Crossref]  [PubMed] 
  18. Cunningham FG, Williams JW. Williams Obstetrics. 22nd ed. New York: McGraw-Hill Publishers; 2005.
  19. Demers S, Roberge S, Afiuni YA, Chaillet N, Girard I, Bujold E. Survey on uterine closure and other techniques for Caesarean section among Quebec's obstetrician-gynaecologists. J Obstet Gynaecol Can. 2013;35(4):329-33. [Crossref]  [PubMed] 
  20. Tuuli MG, Rampersad RM, Carbone JF, Stamilio D, Macones GA, Odibo AO. Staples compared with subcuticular suture for skin closure after cesarean delivery: a systematic review and meta-analysis. Obstet Gynecol. 2011;117(3):682-90. Erratum in: Obstet Gynecol. 2011;117(6):1440. [Crossref]  [PubMed] 
  21. Mackeen AD, Berghella V, Larsen ML. Techniques and materials for skin closure in caesarean section. Cochrane Database Syst Rev. 2012;11(11):CD003577. [Crossref]  [PubMed]  [PMC] 
  22. Papinutti VL, Diorio LA, Forchiassin F. Production of laccase and manganese peroxidase by Fomes sclerodermeus grown on wheat bran. J Ind Microbiol Biotechnol. 2003;30(3):157-60. [Crossref]  [PubMed] 
  23. Hodgson NC, Malthaner RA, Ostbye T. The search for an ideal method of abdominal fascial closure: a meta-analysis. Ann Surg. 2000;231(3):436-42. [Crossref]  [PubMed]  [PMC] 
  24. Kore S, Vyavaharkar M, Akolekar R, Toke A, Ambiye V. Comparison of closure of subcutaneous tissue versus non-closure in relation to wound disruption after abdominal hysterectomy in obese patients. J Postgrad Med. 2000;46(1):26-8. [PubMed] 
  25. van 't Riet M, Steyerberg EW, Nellensteyn J, Bonjer HJ, Jeekel J. Meta-analysis of techniques for closure of midline abdominal incisions. Br J Surg. 2002;89(11):1350-6. [Crossref]  [PubMed] 
  26. Hung HW, Yang PY, Yan YH, Jou HJ, Lu MC, Wu SC. Increased postpartum maternal complications after cesarean section compared with vaginal delivery in 225 304 Taiwanese women. J Matern Fetal Neonatal Med. 2016;29(10):1665-72. [Crossref]  [PubMed] 
  27. Shea SK, Soper DE. Prevention of cesarean delivery surgical site infections. Obstet Gynecol Surv. 2019;74(2):99-110. [Crossref]  [PubMed] 
  28. Gislason H, Grønbech JE, Søreide O. Burst abdomen and incisional hernia after major gastrointestinal operations--comparison of three closure techniques. Eur J Surg. 1995;161(5):349-54. [PubMed] 
  29. Riou JP, Cohen JR, Johnson H Jr. Factors influencing wound dehiscence. Am J Surg. 1992;163(3):324-30. [Crossref]  [PubMed] 
  30. Gruppo M, Mazzalai F, Lorenzetti R, Piatto G, Toniato A, Ballotta E. Midline abdominal wall incisional hernia after aortic reconstructive surgery: a prospective study. Surgery. 2012;151(6):882-8. [Crossref]  [PubMed] 
  31. Varshney S, Manek P, Johnson CD. Six-fold suture:wound length ratio for abdominal closure. Ann R Coll Surg Engl. 1999;81(5):333-6. [PubMed]  [PMC] 
  32. Gislason H, Søreide O, Viste A. Wound complications after major gastrointestinal operations. The surgeon as a risk factor. Dig Surg. 1999;16(6):512-4. [Crossref]  [PubMed] 
  33. Paulsen CB, Zetner D, Rosenberg J. Incisional hernia after cesarean section: A systematic review. Eur J Obstet Gynecol Reprod Biol. 2020;244:128-33. [Crossref]  [PubMed]