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.

A Prospective Randomized Study of Pfannenstiel Versus Expanded Port Site Incision for Intact Specimen Extraction in Laparoscopic Radical Nephrectomy

“…The disadvantages of a vertical midline incision include the greater risk of postoperative wound dehiscence and development of incisional hernia and the scar is cosmetically less pleasing. 16 We encountered no bowel complications or incisional hernias in our study cohort. Seven postoperative wound complications were observed: Four superficial wound infections, one wound gaping after stitch removal, and two wound hematomas.…”

A Prospective Randomized Study of Pfannenstiel Versus Expanded Port Site Incision for Intact Specimen Extraction in Laparoscopic Radical Nephrectomy

“…The disadvantages of a vertical midline incision include the greater risk of postoperative wound dehiscence and development of incisional hernia and the scar is cosmetically less pleasing. 16 We encountered no bowel complications or incisional hernias in our study cohort. Seven postoperative wound complications were observed: Four superficial wound infections, one wound gaping after stitch removal, and two wound hematomas.…”

Caesarean deliveries by Pfannenstiel versus Joel-Cohen incision: A randomised controlled trial

“…Also, the operative time was significantly shorter in the Joel-Cohen technique compared to the Pfannenstiel technique in the studies by Darj et al (13) and Wallin et al (14) and the modified Joel Cohen technique (17,18). Although this study and randomised controlled trials concluded that the time to get out of bed, to walk straight without support, to detect audible intestinal sounds and to pass gases were significantly shorter in the Joel-Cohen group compared to the Pfannenstiel group (6,9,19), the Cochrane systemic review concluded that there was no significant difference between the Joel-Cohen and Pfannenstiel techniques regarding time to return of bowel function, time to mobilisation and/or time to the start of breastfeeding (17,18). There was no significant difference in this study between the Joel Cohen group and the Pfannenstiel group regarding the postoperative hospital stay, while, Moreira et al (6) and Popiela et al (20), concluded that the postoperative hospital stay was significantly shorter in the modified Joel Cohen technique compared to the Pfannenstiel technique.…”

Enhanced recovery after elective caesarean: a rapid review of clinical protocols, and an umbrella review of systematic reviews

“…The quality of evidence was assessed on a scale from “very low” to “high” quality evidence using the GRADE tool. Components demonstrating the greatest impact on length of stay in any surgical setting were delayed umbilical cord clamping (CS / vaginal birth – infant LoS (assumed to be relevant to the mother) reduced by 16.40 days – low quality evidence) [43], minimally invasive Joel-Cohen surgical technique (CS – LoS reduced by 1.5 days – very low quality evidence) [41], preoperative immune enhancing drinks (gastro-intestinal surgery – LoS reduced by 0.97 days - moderate quality evidence) [40] and early postoperative fluids / food (colorectal surgery – LoS reduced by 0.89 days – moderate quality evidence) [46]. Length of stay data was also extracted from eligible ERAS packages and assessed for quality.…”

“…Only 3/25 components were common to all five pathways (early oral intake, mobilization and removal of catheter) demonstrating considerable differences in the composition of enhanced recovery packages between UK maternity units. Of the systematic reviews evaluating single component ERAS interventions in CS, only minimally invasive Joel-Cohen surgical technique [41], early removal of catheter [47] and post-operative antibiotic prophylaxis [44] appeared to show effects that were statistically significant at the 5 percent level. These interventions reduced length of stay by 0.49 to 1.5 days (catheter removal was presented as increased length of stay for indwelling catheter [47]), but the quality of evidence was moderate at best.…”

A Prospective Randomized Study of Pfannenstiel Versus Expanded Port Site Incision for Intact Specimen Extraction in Laparoscopic Radical Nephrectomy

“…The disadvantages of a vertical midline incision include the greater risk of postoperative wound dehiscence and development of incisional hernia and the scar is cosmetically less pleasing. 16 We encountered no bowel complications or incisional hernias in our study cohort. Seven postoperative wound complications were observed: Four superficial wound infections, one wound gaping after stitch removal, and two wound hematomas.…”

Caesarean deliveries by Pfannenstiel versus Joel-Cohen incision: A randomised controlled trial

“…Also, the operative time was significantly shorter in the Joel-Cohen technique compared to the Pfannenstiel technique in the studies by Darj et al (13) and Wallin et al (14) and the modified Joel Cohen technique (17,18). Although this study and randomised controlled trials concluded that the time to get out of bed, to walk straight without support, to detect audible intestinal sounds and to pass gases were significantly shorter in the Joel-Cohen group compared to the Pfannenstiel group (6,9,19), the Cochrane systemic review concluded that there was no significant difference between the Joel-Cohen and Pfannenstiel techniques regarding time to return of bowel function, time to mobilisation and/or time to the start of breastfeeding (17,18). There was no significant difference in this study between the Joel Cohen group and the Pfannenstiel group regarding the postoperative hospital stay, while, Moreira et al (6) and Popiela et al (20), concluded that the postoperative hospital stay was significantly shorter in the modified Joel Cohen technique compared to the Pfannenstiel technique.…”

Enhanced recovery after elective caesarean: a rapid review of clinical protocols, and an umbrella review of systematic reviews

“…The quality of evidence was assessed on a scale from “very low” to “high” quality evidence using the GRADE tool. Components demonstrating the greatest impact on length of stay in any surgical setting were delayed umbilical cord clamping (CS / vaginal birth – infant LoS (assumed to be relevant to the mother) reduced by 16.40 days – low quality evidence) [43], minimally invasive Joel-Cohen surgical technique (CS – LoS reduced by 1.5 days – very low quality evidence) [41], preoperative immune enhancing drinks (gastro-intestinal surgery – LoS reduced by 0.97 days - moderate quality evidence) [40] and early postoperative fluids / food (colorectal surgery – LoS reduced by 0.89 days – moderate quality evidence) [46]. Length of stay data was also extracted from eligible ERAS packages and assessed for quality.…”

“…Only 3/25 components were common to all five pathways (early oral intake, mobilization and removal of catheter) demonstrating considerable differences in the composition of enhanced recovery packages between UK maternity units. Of the systematic reviews evaluating single component ERAS interventions in CS, only minimally invasive Joel-Cohen surgical technique [41], early removal of catheter [47] and post-operative antibiotic prophylaxis [44] appeared to show effects that were statistically significant at the 5 percent level. These interventions reduced length of stay by 0.49 to 1.5 days (catheter removal was presented as increased length of stay for indwelling catheter [47]), but the quality of evidence was moderate at best.…”

A Prospective Randomized Study of Pfannenstiel Versus Expanded Port Site Incision for Intact Specimen Extraction in Laparoscopic Radical Nephrectomy

“…The disadvantages of a vertical midline incision include the greater risk of postoperative wound dehiscence and development of incisional hernia and the scar is cosmetically less pleasing. 16 We encountered no bowel complications or incisional hernias in our study cohort. Seven postoperative wound complications were observed: Four superficial wound infections, one wound gaping after stitch removal, and two wound hematomas.…”

Caesarean deliveries by Pfannenstiel versus Joel-Cohen incision: A randomised controlled trial

“…Also, the operative time was significantly shorter in the Joel-Cohen technique compared to the Pfannenstiel technique in the studies by Darj et al (13) and Wallin et al (14) and the modified Joel Cohen technique (17,18). Although this study and randomised controlled trials concluded that the time to get out of bed, to walk straight without support, to detect audible intestinal sounds and to pass gases were significantly shorter in the Joel-Cohen group compared to the Pfannenstiel group (6,9,19), the Cochrane systemic review concluded that there was no significant difference between the Joel-Cohen and Pfannenstiel techniques regarding time to return of bowel function, time to mobilisation and/or time to the start of breastfeeding (17,18). There was no significant difference in this study between the Joel Cohen group and the Pfannenstiel group regarding the postoperative hospital stay, while, Moreira et al (6) and Popiela et al (20), concluded that the postoperative hospital stay was significantly shorter in the modified Joel Cohen technique compared to the Pfannenstiel technique.…”

Enhanced recovery after elective caesarean: a rapid review of clinical protocols, and an umbrella review of systematic reviews

“…The quality of evidence was assessed on a scale from “very low” to “high” quality evidence using the GRADE tool. Components demonstrating the greatest impact on length of stay in any surgical setting were delayed umbilical cord clamping (CS / vaginal birth – infant LoS (assumed to be relevant to the mother) reduced by 16.40 days – low quality evidence) [43], minimally invasive Joel-Cohen surgical technique (CS – LoS reduced by 1.5 days – very low quality evidence) [41], preoperative immune enhancing drinks (gastro-intestinal surgery – LoS reduced by 0.97 days - moderate quality evidence) [40] and early postoperative fluids / food (colorectal surgery – LoS reduced by 0.89 days – moderate quality evidence) [46]. Length of stay data was also extracted from eligible ERAS packages and assessed for quality.…”

“…Only 3/25 components were common to all five pathways (early oral intake, mobilization and removal of catheter) demonstrating considerable differences in the composition of enhanced recovery packages between UK maternity units. Of the systematic reviews evaluating single component ERAS interventions in CS, only minimally invasive Joel-Cohen surgical technique [41], early removal of catheter [47] and post-operative antibiotic prophylaxis [44] appeared to show effects that were statistically significant at the 5 percent level. These interventions reduced length of stay by 0.49 to 1.5 days (catheter removal was presented as increased length of stay for indwelling catheter [47]), but the quality of evidence was moderate at best.…”