A review of Caesarean section techniques and postoperative thromboprophylaxis at a tertiary hospital

<p><b>INTRODUCTION</b>Although Caesarean sections (CSs) are among the most commonly undertaken procedures in the world, there are wide variations in the surgical techniques used. This study aimed to: (a) review the surgical techniques used for CS by obstetricians working in a tertiary hospital in Singapore; (b) compare the techniques with those recommended in evidence-based guidelines; and (c) examine the relationship between the technique used and the level of seniority of the surgeons.</p><p><b>METHODS</b>Data on 490 CSs performed in Singapore General Hospital (SGH) between 1 August 2013 and 30 June 2014 was collected from the Delivery Suite database and reviewed. The surgical techniques studied were closure of the pelvic and parietal peritoneum, closure of the uterine layer, use of surgical drains and use of postoperative thromboprophylaxis.</p><p><b>RESULTS</b>A total of 486 CSs were analysed after four cases were excluded due to missing data. Most fetal head deliveries were manual. The majority of surgeons did not close the peritoneum; most of those who did were senior surgeons. Double-layer uterine closures were done for all cases and drain usage was rare. 2.0% of the patients received grossly inadequate thromboprophylaxis.</p><p><b>CONCLUSION</b>The surgical techniques currently practised in SGH are closely aligned with those of the evidence-based guidelines. Peritoneal closure appears to be associated with the surgeon's early training, with a greater number of senior surgeons being less willing to abandon this step. Greater vigilance in implementing appropriate thromboprophylaxis is recommended.</p>

Complicaciones posoperatorias en la operación cesárea sin sutura del plano peritoneal / Postoperative complications in cesarean section without suture of peritoneal plane

La cesárea constituye el proceder quirúrgico que más se realiza en el mundo. Esta operación sin sutura peritoneal reporta múltiples ventajas, es recomendable por su simplicidad, su fácil ejecución y la virtud de ahorrar tiempo quirúrgico, con menos complicaciones. OBJETIVOS: Describir las complicaciones posoperatorias en mujeres cesareadas sin sutura y con sutura peritoneal. MÉTODOS: Se realizó un estudio prospectivo de evaluación de técnica quirúrgica sin sutura peritoneal en 427 mujeres cesareadas en el ISMM "Dr. Luis Díaz Soto" y se comparó con un grupo control a las que se le aplicó la técnica convencional con sutura de ambos peritoneos, desde octubre del 2002 hasta marzo del 2006. Se incluyeron pacientes hasta con una sola cesárea anterior y anestesia regional. Fueron estudiadas diferentes variables: fiebre, sepsis urinaria, endometritis, complicaciones de la pared abdominal, Íleo paralítico, uso de antibióticos terapéuticos y estadía posquirúrgica. Para el análisis se utilizó la prueba de Chi-Cuadrado de homogeneidad entre grupos y la prueba t de Student, con un nivel de significación de 0,05. RESULTADOS: Presentaron complicaciones un porcentaje menor de las pacientes del grupo estudio, dentro de estas con significación estadística la fiebre postoperatoria (15 % vs. 22,9 %) y las patologías de la pared abdominal (74,5 vs. 25,5 %), con una reducción significativa en la indicación de antibióticos (11 % vs. 26,6 %) y de la estadía posquirúrgica (4,1 y 5,0 días, respectivamente). CONCLUSIÓN: Se evidenció que la sutura rutinaria del plano peritoneal en la operación cesárea puede omitirse de forma segura, existiendo menos complicaciones y más rápida recuperación

The cesarean section is the surgical procedure more carried out in the world. This operation without peritoneal suture reports many advantages ant it is recommendable due to its simplicity, its easy performing and the saving of surgical time without less complications. OBJECTIVES: To describe the postpartum complications in women underwent without and with peritoneal suture cesarean section. METHODS: A prospective study was conducted to assess the surgical technique without peritoneal suture applied in 427 underwent cesarean section in the "Dr. Luis DÝaz Soto" Military Medicine Higher Institute (MMHI) compared with a control group using the conventional technique with suture of both peritoneums from October, 2002 to March, 2006. Patients included underwent only one previous cesarean section and regional anesthesia. Different variable were studied: fever, urinary sepsis, endometritis, complications of abdominal wall, paralyticus ileus, therapeutical antibiotics use and postsurgical stage. For analysis we used the Chi² test of homogeneity among groups and the t Student test with a significance level of 0.05. RESULTS: Less women from the study group has statistic significant complications including postoperative fever (15 percent versus 22,9 percent) ant the abdominal wall pathologies (74.5 percent versus 25.5 percent) with a marked reduction in the antibiotic prescription (11 percent versus 26,6 percent) and the postsurgical stage (4.1 and 5.0 days, respectively). CONCLUSIONS: It was evidenced that the rutine suture of peritoneal plane in cesarean section may be omitted in an accurate way and the result was less complications and a faster recovery

Postoperative adhesions in different peritoneal closure techniques in rats

Different techniques of peritoneal closure were evaluated on their effect on the development of postoperative adhesions. Sixty rats were divided into 3 groups of 20 and each group was assigned to one technique. The peritoneum was closed in the 2 groups using different techniques; conventional or edge to edge in the first group and everted edges in the second. In the third group, the peritoneum was not closed. This study showed that there was a significant reduction in the development of postoperative adhesions with one closure of the peritoneum. Suturing of the edges of the peritoneum increased the incidence as well as the severity of postoperative adhesions.