Expression of Concern: Long‐term outcomes of two different surgical techniques for cesarean

Abstract

A modified cesarean delivery technique, including Joel-Cohen incision, exteriorized full thickness suturing of the uterine incision, and non-closure of the peritoneum may reduce long-term morbidities of the procedure.

Comparison of Visual Analog Pain Scores of Two Different Abdominal Incisions for Cesarean Section: Prospective Randomized Trial

“…The mean fetus [12]. Since subaponeurotic dissection is not performed in the Joel-Cohen incision less time is spent for extraction of the fetus.…”

Impact of intrapartum factors on oxidative stress in newborns

“…Gestational age was calculated from the reported first day of the last menstrual period, and was ascertained by ultrasound measurement done before 20 weeks and clinical assessment at birth. All elective lower segment cesarean deliveries were performed at term (completed 37 weeks of gestation) by the modified technique described previously [13].…”

Technical aspects of the cesarean section

“…The omission of the bladder flap (direct incision 1 cm above the bladder fold) was associated with a reduction in operating time (5 vs. 7 min; P=0.001), blood loss [postoperative microhematuria (21% vs. 47%; P=0.01) and need for analgetics (26% vs. 55%; P=.006; 26]. The rate of a bladder adherent to the uterus at repeated cesarean section was demonstrated to be higher in those who had a bladder flap performed in a previous CS [38]. The bladder flap is justified only if a difficult delivery is anticipated like a vertex presentation deep in the pelvis.…”

“…Also the analgetic requirements favor a non-closure. The longterm follow-up showed no differences in pain, fertility, urinary symptoms, and adhesions [38,44,45]. It is proven that closure of the visceral peritoneum at cesarean delivery may produce an inflammatory reaction and adhesions, caused by reactive and regenerative mesothelial hyperplasia and submesothelial fibrosis [33].…”