ABSTRACT
The Joel-Cohen incision followed by nonclosure of pelvic and parietal peritoneum has
been advocated as an alternative method to the Pfannenstiel incision with peri-tonealization
at cesarean section. A randomized trial was designed to compare intra-and postoperative
morbidity between the two techniques. Women to undergo a cesarean section were randomly
allocated to have either the Joel-Cohen incision with the parietal and pelvic peritoneum
left open (group 1) or to have the Pfannenstiel incision with both peritoneal layers
sutured (group 2). The myometrium was closed with 1-0 polyglactin 910 suture using
a continuous single-layer nonlocking technique. Patients in group 2 had the peritoneum
approximated with 2-0 polyglactin 910 suture. The fascia was sutured with continuous
1-0 polyglactin 910 suture in all cases. Opening time was defined as the interval
from skin incision to the opening of the uterine cavity. Febrile morbidity was defined
as a temperature ≥38°C on two occasions 4 hours (hr) apart excluding the first postoperative
day. Endometritis was defined as postpartum temperature ≥38°C on two occasions 4 hr
apart, with uterine tenderness and/or foul-smelling lochia. One hundred forty-nine
and 1 50 patients were allocated to group 1 and to group 2, respectively. A shorter
median (range) opening time [4 min (2-21) vs. 6 min (2-19), respectively, p < 0.01] and a shorter median (range) operative time [30 min (10-65) vs. 40 min (20-110),
respectively, p < 0.01] were observed in group 1. No difference was found in terms of intraoperative
complications, proportion of patients who required transfusion, endometritis, sepsis,
febrile morbidity, and urinary tract infections. A higher rate of wound infections
was found in group 2 than in group 1 [14 of 1 50 (9.3%) vs. 2 of 149 (1.3%), respectively,
p < 0.01]. The Joel-Cohen incision without peritonealization resulted in a shorter
opening and total operative time than the Pfannenstiel laparotomy with peritonealization.
This was accomplished with a reduction of wound infections.
Keywords
Cesarean delivery - postoperative morbidity - Joel-Cohen - Pfannenstiel
