Effect of Closure of Anterior Abdominal Wall Layers on Early Postoperative Findings at Cesarean Section: A Prospective Cross-sectional Study

Abstract

Objective To investigate the effect of closure types of the anterior abdominal wall layers in cesarean section (CS) surgery on early postoperative findings.

Methods The present study was designed as a prospective cross-sectional study and was conducted at a university hospital between October 2018 and February 2019. A total of 180 patients who underwent CS for various reasons were enrolled in the study. Each patient was randomly assigned to one of three groups: Both parietal peritoneum and rectus abdominis muscle left open (group 1), parietal peritoneum closure only (group 2), and closure of the parietal peritoneum and reapproximation of rectus muscle (group 3). All patients were compared in terms of postoperative pain scores (while lying down and during mobilization), analgesia requirement, and return of bowel motility.

Results The postoperative pain scores were similar at the 2^nd, 6^th, 12^th, and 18^th hours while lying down. During mobilization, the postoperative pain scores at 6 and 12 hours were significantly higher in group 2 than in group 3. Diclofenac use was significantly higher in patients in group 1 than in those in group 2. Meperidine requirements were similar among the groups. There was no difference between the groups' first flatus and stool passage times.

Conclusion In the group with only parietal peritoneum closure, the pain scores at the 6^th and 12^th hours were higher. Rectus abdominis muscle reapproximations were found not to increase the pain score. The closure of the anterior abdominal wall had no effect on the return of bowel motility.

Keywords

analgesia - cesarean - intestinal motility - parietal peritoneum - rectus abdominis muscle

Contributions

All the authors contributed equally to this paper, namely to the conception and design, data collection or analysis, and interpretation of data, writing of the article, and review of the intellectual content. Therefore, all authors approved the final version to be published.

Publication History

Received: 20 June 2020

Accepted: 08 December 2020

Article published online:
30 March 2021

• References

• 1 Boerma T, Ronsmans C, Melesse DY, Barros AJD, Barros FC, Juan L. et al. Global epidemiology of use of and disparities in caesarean sections. Lancet 2018; 392 (10155): 1341-1348 DOI: 10.1016/S0140-6736(18)31928-7.
• 2 Boatin AA, Schlotheuber A, Betran AP, Moller AB, Barros AJD, Boerma T. et al. Within country inequalities in caesarean section rates: observational study of 72 low and middle income countries. BMJ 2018; 360: k55 DOI: 10.1136/bmj.k55.
• 3 Encarnacion B, Zlatnik MG. Cesarean delivery technique: evidence or tradition? A review of the evidence-based cesarean delivery. Obstet Gynecol Surv 2012; 67 (08) 483-494 DOI: 10.1097/OGX.0b013e318267699f.
• 4 Popov I, Stoĭkov S, Bakŭrdzhiev G, Khristova P. [A single-stage 2-layer suture in cesarean section--the effect of the surgical technic on postoperative febrile conditions]. Akush Ginekol (Sofiia) 1994; 33 (02) 13-15 Bulgarian.
• 5 Cheong YC, Premkumar G, Metwally M, Peacock JL, Li TC. To close or not to close? A systematic review and a meta-analysis of peritoneal non-closure and adhesion formation after caesarean section. Eur J Obstet Gynecol Reprod Biol 2009; 147 (01) 3-8 DOI: 10.1016/j.ejogrb.2009.06.003.
• 6 Bamigboye AA, Hofmeyr GJ. Closure versus non-closure of the peritoneum at caesarean section: short- and long-term outcomes. Cochrane Database Syst Rev 2014; (08) CD000163 DOI: 10.1002/14651858.CD000163.pub2.
• 7 Kapustian V, Anteby EY, Gdalevich M, Shenhav S, Lavie O, Gemer O. Effect of closure versus nonclosure of peritoneum at cesarean section on adhesions: a prospective randomized study. Am J Obstet Gynecol 2012; 206 (01) 56.e1-56.e4 DOI: 10.1016/j.ajog.2011.07.032.
• 8 Lyell DJ, Naqvi M, Wong A, Urban R, Carvalho B. Rectus muscle reapproximation at cesarean delivery and postoperative pain: a randomized controlled trial. Surg J (N Y) 2017; 3 (03) e128-e133 DOI: 10.1055/s-0037-1604074.
• 9 Omran EF, Meshaal H, Hassan SM, Dieb AS, Nabil H, Saad H. The effect of rectus muscle re-approximation at cesarean delivery on pain perceived after operation: a randomized control trial. J Matern Fetal Neonatal Med 2019; 32 (19) 3238-3243 DOI: 10.1080/14767058.2018.1461829.
• 10 Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007; 39 (02) 175-191 DOI: 10.3758/bf03193146.
• 11 Koc I. Increased cesarean section rates in Turkey. Eur J Contracept Reprod Health Care 2003; 8 (01) 1-10
• 12 Santas G, Santas F. Trends of caesarean section rates in Turkey. J Obstet Gynaecol 2018; 38 (05) 658-662 DOI: 10.1080/01443615.2017.1400525.
• 13 Stegwee SI, Jordans I, van der Voet LF, van de Ven PM, Ket J, Lambalk CB. et al. Uterine caesarean closure techniques affect ultrasound findings and maternal outcomes: a systematic review and meta-analysis. BJOG 2018; 125 (09) 1097-1108 DOI: 10.1111/1471-0528.15048.
• 14 Dodd JM, Anderson ER, Gates S, Grivell RM. Surgical techniques for uterine incision and uterine closure at the time of caesarean section. Cochrane Database Syst Rev 2014; (07) CD004732 DOI: 10.1002/14651858.CD004732.pub3.
• 15 AbdElaal NK, Ellakwa HE, Elhalaby AF, Shaheen AE, Aish AH. Scalpel versus diathermy skin incision in Caesarean section. J Obstet Gynaecol 2019; 39 (03) 340-344 DOI: 10.1080/01443615.2018.1527298.
• 16 Shinde G, Pawar A, Jadhav B, Rathod K. Modified extraperitoneal Caesarean section: clinical experience. Trop Doct 2012; 42 (04) 188-190 DOI: 10.1258/td.2012.120241.
• 17 Vachon-Marceau C, Demers S, Bujold E, Roberge S, Gauthier RJ, Pasquier JC. et al. Single versus double-layer uterine closure at cesarean: impact on lower uterine segment thickness at next pregnancy. Am J Obstet Gynecol 2017; 217 (01) 65.e1-.e5 DOI: 10.1016/j.ajog.2017.02.042.
• 18 Palatnik A, Grobman WA. The association of skin-incision type at cesarean with maternal and neonatal morbidity for women with multiple prior cesarean deliveries. Eur J Obstet Gynecol Reprod Biol 2015; 191: 121-124 DOI: 10.1016/j.ejogrb.2015.06.009.
• 19 Daykan Y, Sharon-Weiner M, Pasternak Y, Tzadikevitch-Geffen K, Markovitch O, Sukenik-Halevy R. et al. Skin closure at cesarean delivery, glue vs subcuticular sutures: a randomized controlled trial. Am J Obstet Gynecol 2017; 216 (04) 406.e1-406.e5 DOI: 10.1016/j.ajog.2017.01.009.
• 20 Di Spiezio Sardo A, Saccone G, McCurdy R, Bujold E, Bifulco G, Berghella V. Risk of Cesarean scar defect following single- vs double-layer uterine closure: systematic review and meta-analysis of randomized controlled trials. Ultrasound Obstet Gynecol 2017; 50 (05) 578-583 DOI: 10.1002/uog.17401.
• 21 Shi Z, Ma L, Yang Y, Wang H, Schreiber A, Li X. et al. Adhesion formation after previous caesarean section-a meta-analysis and systematic review. BJOG 2011; 118 (04) 410-422 DOI: 10.1111/j.1471-0528.2010.02808.x.
• 22 Dahlke JD, Mendez-Figueroa H, Rouse DJ, Berghella V, Baxter JK, Chauhan SP. Evidence-based surgery for cesarean delivery: an updated systematic review. Am J Obstet Gynecol 2013; 209 (04) 294-306 DOI: 10.1016/j.ajog.2013.02.043.
• 23 Ge W, Chen G, Ding YT. Effect of chewing gum on the postoperative recovery of gastrointestinal function. Int J Clin Exp Med 2015; 8 (08) 11936-11942
• 24 Altraigey A, Ellaithy M, Atia H, Abdelrehim W, Abbas AM, Asiri M. The effect of gum chewing on the return of bowel motility after planned cesarean delivery: a randomized controlled trial. J Matern Fetal Neonatal Med 2020; 33 (10) 1670-1677 DOI: 10.1080/14767058.2018.1526913.
• 25 Huang H, Wang H, He M. Early oral feeding compared with delayed oral feeding after cesarean section: a meta-analysis. J Matern Fetal Neonatal Med 2016; 29 (03) 423-429 DOI: 10.3109/14767058.2014.1002765.