Rectus muscle re-approximation in cesarean section — a surgical dilemma: to close or not to close?
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Abstract
Objectives: Cesarean section is one of the most common operations worldwide since decades. However, the optimum surgical cesarean section technique is still being discussed. Closure or non-closure of the rectus muscles is also unclear among obstetricians. We aimed to evaluate the effect of rectus muscle re-approximation (RMR) in cesarean section on postoperative pain among singleton primi gravida elective cesarean sections at term.
Material and methods: The current study was planned as a prospective, blinded, randomized controlled trial. A total of 279 elective primi gravida singleton cesarean sections; 142 undergoing RMR and 137 not-undergoing RMR were included in the study. All participants were managed with our clinic’s postoperative protocol and obstetric outcomes were also recorded. The patients’ pain was assessed face to face 24 hours and 48 hours after operation by using visual analog scale (VAS) score.
Results: The elective singleton primi gravida cesarean sections with and without RMR exhibited no significant difference with respect to maternal age, Body Mass Index, delivery week and other obstetric outcomes. The VAS scores at 24th and 48th hours (67 ± 24 versus 69 ± 25, p: 0.635; 47 ± 25 versus 52 ± 26, p: 0,126, respectively) were similar between the RMR and non-RMR group.
Conclusions: RMR has not any negative effect on postoperative pain, operation time, analgesic use and hospital stay in singleton primi gravida elective CS at term. Additionally, RMR did not lead to any adverse postoperative risks such as increased blood loss and sub-rectus hematoma.
Keywords: cesarean sectionrectus muscle re-approximationpostoperative pain
References
- WHO. Caesarean section rates continue to rise, amid growing inequalities in access; 2021.
- Santas G, Santas F. Trends of caesarean section rates in Turkey. J Obstet Gynaecol. 2018; 38(5): 658–662.
- İnai ZO, İnal HA, Kucukkendirici H, et al. İnvestigation of cesarean sections at Konya Training and Research Hospital Obstetrics and Gynecology Department between 2010 and 2015. Ginekol Pol. 2017; 88(4): 185–190.
- Ulgu MM, Birinci S, Altun Ensari T, et al. Cesarean section rates in Turkey 2018-2023: Overview of national data by using Robson ten group classification system. Turk J Obstet Gynecol. 2023; 20(3): 191–198.
- Hasdemir PS, Terzi H, Guvenal T. What are the best surgical techniques for caesarean sections? A contemporary review. J Obstet Gynaecol. 2016; 36(2): 141–145.
- Lyell DJ, Power M, Murtough K, et al. Surgical Techniques at Cesarean Delivery: A U.S. Survey. Surg J (N Y). 2016; 2(4): e119–e125.
- Çintesun E, İncesu Çintesun FN, Aydoğdu M, et al. Effect of re-approximation of the rectus muscles on diastasis recti abdominis at cesarean section - a prospective cross-sectional study. Ginekol Pol. 2021; 92(2): 132–136.
- Lyell DJ, Naqvi M, Wong A, et al. Rectus Muscle Reapproximation at Cesarean Delivery and Postoperative Pain: A Randomized Controlled Trial. Surg J (N Y). 2017; 3(3): e128–e133.
- Omran EF, Meshaal H, Hassan SM, et al. 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.
- Çintesun E, Kebapçılar AG, Uçar MG, et al. Effect of Closure of Anterior Abdominal Wall Layers on Early Postoperative Findings at Cesarean Section: A Prospective Cross-sectional Study. Rev Bras Ginecol Obstet. 2021; 43(4): 250–255.
- Demir Çaltekin M, Doğan H, Onat T, et al. The effect of rectus reapproximation on postoperative muscle strength and core endurance in cesarean section: A prospective case-control study. J Obstet Gynaecol Res. 2022; 48(3): 709–718.
- Berghella V, Baxter J, Chauhan S. Evidence-based surgery for cesarean delivery. American Journal of Obstetrics and Gynecology. 2005; 193(5): 1607–1617.
- Lyell DJ, Caughey AB, Hu E, et al. Rectus muscle and visceral peritoneum closure at cesarean delivery and intraabdominal adhesions. Am J Obstet Gynecol. 2012; 206(6): 515.e1–515.e5.
