Abdominal surgical incisions for caesarean section

Abstract

The Joel-Cohen incision has advantages compared to the Pfannenstiel incision. These are less fever, pain and analgesic requirements; less blood loss; shorter duration of surgery and hospital stay. These advantages for the mother could be extrapolated to savings for the health system. However, these trials do not provide information on severe or long-term morbidity and mortality.

Obesity and the challenges of caesarean delivery: Prevention and management of wound complications

“…Likewise, the choice between a Pfannenstiel and a Joel-Cohen incision in obese patients has not been the subject of investigation. There is some evidence from RCTs to suggest that the Joel-Cohen incision has advantages over the Pfannenstiel incision in the general population, with a reduction in post-operative febrile morbidity (RR 0.35, 95% CI 0.14e0.87), in delivery and operating time, as well as estimated blood loss and post-operative analgesic requirements [32]. In obese patients, however, it is generally easy with Pfannenstiel incisions to dissect the subcutaneous tissue upwards and open the rectus sheath above the pyramidalis muscles, as would occur in the Joel-Cohen incision.…”

The association of skin-incision type at cesarean with maternal and neonatal morbidity for women with multiple prior cesarean deliveries

“…In current practice, most women undergo repeat CD through a transverse skin incision, such as the Pfannenstiel or the Joel-Cohen, which provides better cosmetic results and carries a lower risk of incisional hernia [8]. Vertical skin incisions typically have been reserved for emergent situations necessitating expeditious delivery, or in settings when it is thought that greater exposure may be necessary (e.g., planning for cesarean hysterectomy) [8].…”

“…Vertical skin incisions typically have been reserved for emergent situations necessitating expeditious delivery, or in settings when it is thought that greater exposure may be necessary (e.g., planning for cesarean hysterectomy) [8]. It is possible, however, that more routine use of vertical skin incisions may provide advantage for women who have had multiple prior CDs by enabling dense adhesions in the lower abdomen to be avoided more readily, by reducing blood loss, and by allowing greater ease for cephalad extension of the skin incision if more space is required for uterine and fetal access.…”

“…Although a large portion of that risk is attributable to abnormal placentation [1,2], maternal complications related to dense adhesions encountered at the time of repeat CD also have been reported as a cause of significant morbidity [4]. The frequency of severe adhesions, moreover, increases with the number of CDs [2][3][4]6,7].In current practice, most women undergo repeat CD through a transverse skin incision, such as the Pfannenstiel or the Joel-Cohen, which provides better cosmetic results and carries a lower risk of incisional hernia [8]. Vertical skin incisions typically have been reserved for emergent situations necessitating expeditious delivery, or in settings when it is thought that greater exposure may be necessary (e.g., planning for cesarean hysterectomy) [8].…”

Comparison of uterine exteriorization and in situ repair during cesarean sections

“…Different operational techniques have been defined to reduce the risk of peri-and postoperative morbidity [1]. Randomized, controlled studies have revealed discordant results regarding the optimal surgical technique [2][3][4][5][6]. The uterine repair site has been a major concern when evaluating surgical techniques.…”