E-ISSN: 2619-9467

Contents    Cover    Publication Date: 19 Apr 2024
Year 2024 - Volume 34 - Issue 1

Open Access

Peer Reviewed

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The Effects of Uterine Closure Techniques Single Layer Locking, Modified Lembert, and Laterally Continuing Suture on Uterine Scar Development: A Cohort Research

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JCOG. 2024;34(1):10-8
DOI: 10.5336/jcog.2023-98178
Article Language: EN
Copyright Ⓒ 2020 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/)
Objective: Incomplete healing of a cesarean scar is a mid-term complication of cesarean section and is widely known to be associated with many gynecological symptoms. In this study, we evaluated the correlation between uterine closure suture techniques in the development of uterine scar defect after cesarean section. Material and Methods: The study was conducted prospectively with 131 patients who applied to single center between April 2022 and September 2022, who had an emergency or elective cesarean section indication and had their first cesarean section. Three types of suture techniques were applied to the cesarean section: 42 with single-layer locking (Group 1), 44 with modified Lembert (Group 2), and 45 with sutures continuing from the lateral to the medial (Group 3). Scar thickness-hyperechogenicity, myometrial thickness-vascularization, operating time and number of sutures used for closure of the uterus evaluated by transvaginal ultrasonography (TVUSG) in patients who were called for control at the postoperative 6th week after cesarean section were compared between the groups. Results: The scar thickness detected by TVUSG at postoperative 6th week; in the modified Lembert suture technique, it was found to be less than the other two suture types (p=0.001). Myometrial thickness was also observed to be less in the modified Lembert suture technique compared to the other two groups (p=0.019). Conclusion: In this study, it was shown that the uterine scar and myometrium thickness were thinner and the scar hypercogeneity was less in the modified Lembert closure suture technique in the evaluation performed with TVUSG at the 6th week.
  1. Hamilton BE, Martin JA, Ventura SJ. Births: preliminary data for 2012. Natl Vital Stat Rep. 2013;62(3):1-20. [PubMed] 
  2. Küçükbaş GN, Moraloğlu O, Özel S, Erkaya S, Taşcı Y, Fındık RB. The cesarean rates and indications between 2010 and 2014 in the Obstetrics Department of Dr. Zekai Tahir Burak Maternal Health Training and Research Hospital. Perinatal J. 2016;24(2):61-5. [Crossref] 
  3. Cunningham FG, Gant NF, Leveno KJ. Williams obstetrics. In: Cunningham FG, Gant NF, Leveno KJ, Gilstrap LC, Wenstrom KD, eds. Cesarean Section and Postpartum Hysterectomy. 21st ed. Texas: McGraw Hill; 2001. p.537-65.
  4. DeCherney AH, Nathan L. Cesarean section. Current Obstetrics and Gynecologic Diagnosis and Treatment. 9th ed. New York: Mcgraw Hill T P & R; 2002. p.518-29.
  5. Çiçek MN. Sezaryen. Çiçek MN, Akyürek C, Çelik Ç, Haberal A, editörler. Kadın Hastalıkları ve Doğum Bilgisi. 2. Baskı. Ankara: Güneş Kitabevi; 2006. p.577-95.
  6. Flamm BL. Cesarean section: a worldwide epidemic? Birth. 2000;27(2):139-40. [Crossref]  [PubMed] 
  7. Scioscia M, Vimercati A, Cito L, Chironna E, Scattarella D, Selvaggi LE. Social determinants of the increasing caesarean section rate in Italy. Minerva Ginecol. 2008;60(2):115-20. [PubMed] 
  8. Seiler CM, Deckert A, Diener MK, Knaebel HP, Weigand MA, Victor N, et al. Midline versus transverse incision in major abdominal surgery: a randomized, double-blind equivalence trial (POVATI: ISRCTN60734227). Ann Surg. 2009;249(6):913-20. [Crossref]  [PubMed] 
  9. Dikmen S, Aslan Çetin B, Gedikbaşı A, Kıyak H, Köroğlu N. The outcomes of extending uterine incision transversely or cephalocaudally in patients with previous cesarean section: a prospective randomized controlled study. Perinatal Journal. 2017;25(1):1-5. [Crossref] 
  10. Fabres C, Arriagada P, Fernández C, Mackenna A, Zegers F, Fernández E. Surgical treatment and follow-up of women with intermenstrual bleeding due to cesarean section scar defect. J Minim Invasive Gynecol. 2005;12(1):25-8. [Crossref]  [PubMed] 
  11. van Horenbeeck A, Temmerman M, Dhont M. Cesarean scar dehiscence and irregular uterine bleeding. Obstet Gynecol. 2003;102:1137-9. [Crossref]  [PubMed] 
  12. Hauth JC, Owen J, Davis RO. Transverse uterine incision closure: one versus two layers. Am J Obstet Gynecol. 1992;167(4 Pt 1):1108-11. [Crossref]  [PubMed] 
  13. Ferrari AG, Frigerio LG, Candotti G, Buscaglia M, Petrone M, Taglioretti A, et al. Can Joel-Cohen incision and single layer reconstruction reduce cesarean section morbidity? Int J Gynaecol Obstet. 2001;72(2):135-43. [Crossref]  [PubMed] 
  14. Florio P, Filippeschi M, Moncini I, Marra E, Franchini M, Gubbini G. Hysteroscopic treatment of the cesarean-induced isthmocele in restoring infertility. Curr Opin Obstet Gynecol. 2012;24(3):180-6. [Crossref]  [PubMed] 
  15. Wang CB, Chiu WW, Lee CY, Sun YL, Lin YH, Tseng CJ. Cesarean scar defect: correlation between Cesarean section number, defect size, clinical symptoms and uterine position. Ultrasound Obstet Gynecol. 2009;34(1):85-9. [Crossref]  [PubMed] 
  16. Bij de Vaate AJ, Brölmann HA, van der Voet LF, van der Slikke JW, Veersema S, Huirne JA. Ultrasound evaluation of the Cesarean scar: relation between a niche and postmenstrual spotting. Ultrasound Obstet Gynecol. 2011;37(1):93-9. [Crossref]  [PubMed] 
  17. van der Voet LF, Bij de Vaate AM, Veersema S, Brölmann HA, Huirne JA. Long-term complications of caesarean section. The niche in the scar: a prospective cohort study on niche prevalence and its relation to abnormal uterine bleeding. BJOG. 2014;121(2):236-44. [Crossref]  [PubMed] 
  18. Naji O, Abdallah Y, Bij De Vaate AJ, Smith A, Pexsters A, Stalder C, et al. Standardized approach for imaging and measuring Cesarean section scars using ultrasonography. Ultrasound Obstet Gynecol. 2012;39(3):252-9. [Crossref]  [PubMed] 
  19. Vervoort AJ, Uittenbogaard LB, Hehenkamp WJ, Brölmann HA, Mol BW, Huirne JA. Why do niches develop in Caesarean uterine scars? Hypotheses on the aetiology of niche development. Hum Reprod. 2015;30(12):2695-702. [Crossref]  [PubMed]  [PMC] 
  20. Roberge S, Demers S, Girard M, Vikhareva O, Markey S, Chaillet N, et al. Impact of uterine closure on residual myometrial thickness after cesarean: a randomized controlled trial. Am J Obstet Gynecol. 2016;214(4):507.e1-507.e6. [Crossref]  [PubMed] 
  21. Tepper R, Beyth Y, Klein Z, Aviram R. Postmyomectomy sonographic imaging: uterus remodeling and scar repair. Arch Gynecol Obstet. 2009;280(3):509-11. [Crossref]  [PubMed] 
  22. Armstrong V, Hansen WF, Van Voorhis BJ, Syrop CH. Detection of cesarean scars by transvaginal ultrasound. Obstet Gynecol. 2003;101(1):61-5. [Crossref]  [PubMed] 
  23. Ponsky L, Bream M. Suture techniques. In: Smith JA, Howards SS, Preminger GM, Dmochowski RR, eds. Hinman's Atlas of Urologic Surgery Revised Reprint. 4th ed. Elsevier: 2020. p.11-8.
  24. Dodd JM, Anderson ER, Gates S, Grivell RM. Surgical techniques for uterine incision and uterine closure at the time of caesarean section. Cochrane Database Syst Rev. 2014;(7):CD004732. [Crossref]  [PubMed] 
  25. CAESAR study collaborative group. Caesarean section surgical techniques: a randomised factorial trial (CAESAR). BJOG. 2010;117(11):1366-76. [Crossref]  [PubMed] 
  26. Berghella V, Baxter JK, Chauhan SP. Evidence-based surgery for cesarean delivery. Am J Obstet Gynecol. 2005;193(5):1607-17. [Crossref]  [PubMed] 
  27. Roberge S, Chaillet N, Boutin A, Moore L, Jastrow N, Brassard N, et al. Single- versus double-layer closure of the hysterotomy incision during cesarean delivery and risk of uterine rupture. Int J Gynaecol Obstet. 2011;115(1):5-10. [Crossref]  [PubMed] 
  28. Şekerci Baran F, Avcı ME, Cakıroğlu AY, Çorakcı A. Sezaryende tek veya cift kat kapatma tekniklerinin uterin skar olusumuna etkisi [The effect of single-or double-layer closure of the uterine incision at cesarean section on uterine scar formation]. IKSST Derg. 2018;10(1):25-31. [Crossref] 
  29. Yasmin S, Sadaf J, Fatima N. Impact of methods for uterine incision closure on repeat caesarean section scar of lower uterine segment. J Coll Physicians Surg Pak. 2011;21(9):522-6. [PubMed] 
  30. Ceci O, Cantatore C, Scioscia M, Nardelli C, Ravi M, Vimercati A, Bettocchi S. Ultrasonographic and hysteroscopic outcomes of uterine scar healing after cesarean section: comparison of two types of single-layer suture. J Obstet Gynaecol Res. 2012;38(11):1302-7. [Crossref]  [PubMed] 
  31. Stegwee SI, Jordans I, van der Voet LF, van de Ven PM, Ket J, Lambalk CB, et al. Uterine caesarean closure techniques affect ultrasound findings and maternal outcomes: a systematic review and meta-analysis. BJOG. 2018;125(9):1097-108. Erratum in: BJOG. 2019;126(3):431. [Crossref]  [PubMed]