Abdominal surgical incisions for caesarean section

Comparisons of the morbidity outcomes in repeated cesarean sections using midline and Pfannenstiel incisions

“…The number of intra-operative risks in causing trauma to the internal organs after repeated cesarean section was derived from the study by Makoha et al, which showed that the rates of bladder injuries among women who have had repeated cesarean section using the low midline incision and Pfannenstiel incision were 2.22% and 0.33%, respectively. 3 The sample size calculation also incorporated the information from the secondary objectives, such as the time it took from incision to delivery of the baby, total number of hours required to complete the operation, other intraoperative complications and postpartum complications. Once all of these values were plugged into the equation, a total of 160 women were needed per group in order to have sufficient statistical power (a = 0.05, b = 0.1).…”

“…The type of incision used is dependent upon several factors, such as (but not limited to) the current clinical situation of the patient and the preferences of the operator. 3,4 Among the vertical and transverse incisions, the most common technique used in each type is the low midline and Pfannenstiel incisions, respectively. For the low midline incision, the skin is incised in the midline between the umbilicus and the pubic symphysis.…”

“…The disadvantages of using this type of incision are the increased risks of developing postoperative wound dehiscence, incisional hernia and a prominent, less aesthetic scar. 3 As for the transverse incision, Pfannenstiel is traditionally used for cesarean delivery. Generally, this incision is made at least 2 inches above the pubic symphysis area.…”

“…On the other hand, this incision is more time-consuming and its disadvantages lie in the fact that many hemorrhages may occur during the procedure as well as difficulties in elongating the incision to provide a larger working space when needed. 3 With that said, there is no doubt that both techniques can be used for cesarean sections successfully. However, the problem is which incision is the best for repeated cesarean sections without causing much damage.…”

“…There are very few studies investigating which type of incision should be used for women who have had several cesarean sections and, to make matters worse, none of the studies could come to an agreement on the matter. 3,4 For some obstetricians, the low midline incision is preferred because it is believed to be a safer way to enter the abdomen without causing much injury to the abdominal viscera, especially to the urinary bladder and bowel. This type of thinking is rejected by Makoha et al who stated that the low midline incision was not safe but was significantly more risky than Pfannenstiel in causing injury to the bladder.…”