Modified Misgav Ladach Method for Cesarean Section: Clinical Experience

Abstract

Objective: To determine the advantages of modified a Misgav Ladach method over conventional (Pfannenstiel-Dörffler) cesarean section. Study Design: From October 2002 to March 2005, 217 cesarean sections performed according to a modified Misgav Ladach method (without routine preoperative urinary catheterization, blunt separation of the fascia after a small incision, and unprepared plica vesicouterina) were prospectively compared with 153 randomly selected conventional cesarean sections. Maternal age, parity, gestational age, neonatal birth weight, procedure duration, operative complications and postoperative course were analyzed. Results: The incidence of postoperative fever was 2.30 and 4.57% (p = 0.001), wound seroma 0.46 and 1.96% (p = 0.01), local wound infection 0.92 and 1.96% (p = 0.01), wound dehiscence 0 and 0.65% (NS), anemia 3.68 and 7.84% (p = 0.001), and need of blood transfusion 1.38 and 1.96% (NS) in the modified Misgav Ladach and conventional group, respectively. The mean duration of the operation was 26.24 min with the Misgav Ladach versus 39.41 min with the conventional operation (p < 0.001). The postoperative use of antibiotics and analgesics/antipyretics was significantly lower in the modified Misgav Ladach group (p = 0.001). Conclusion: Study results demonstrated that the modified Misgav Ladach method of cesarean section is associated with faster postoperative recovery, lower morbidity and blood loss, shorter length of operative procedure, lower incidence of operative complications, lesser postoperative use of antibiotics and analgesics/antipyretics, and lower utilization of surgical material. The modified Misgav Ladach method of cesarean section is suitable for emergency and elective procedures, justifying its use in daily routine.

Comparative study of Misgav-Ladach and Pfannenstiel-Kerr cesarean techniques: a randomized controlled trial

“…Joel-Cohen incision at cesarean section was claimed to be a faster method of delivering the fetus than both the Pfannenstiel incision and the mid-line longitudinal incision [10,12,14,15]. Reduction in total operation and extraction times via MLM in our population seems to be compatible with the growing body of literature in this manner [2,3,5].…”

“…To be a faster method, C/S has been a well-documented advantage of MLM [5] associated with benefits of the method in the case of emergency C/S compared to elective surgery [2,3,5,12,14,15,18]. Moreover, less time spent in the operating room allows the obstetric team to spend more time in the labor ward, especially in overcrowded and inadequately staffed labor wards [13].…”

“…In an attempt to simplify the surgical procedure and minimize the tissue damage, the Joel-Cohen method was modified by Stark and coworkers [3] at Misgav-Ladach General Hospital in Jerusalem, leading to a unique improvement of the modified Misgav-Ladach method (MLM) [4][5][6]. Although reduction in operation time was not the purpose of this innovation, it has become the most evident and considerable outcome [2].…”

Modified Misgav Ladach Method versus Pfannenstiel Kerr Method in Women with Previous Cesarean Section: a Randomized Controlled Trial

“…MLM being a faster method of cesarean section is associated with benefits of the method in the case of emergency caesarean section compared to elective surgery [16]. Moreover, less time spent in the operating room…”

Towards a unified evidence-based cesarean section in the african continent the introduction of the all-african surgical database

“…Details which are not in the scope of this study, such as the location of the surgeon during surgery or the usage or omission of abdominal packs, do influence the outcome [21]. There is enough evidence that the outcome of the following suggested method is a reduced need for analgesics and shorter operation time [22].…”