open access

Vol 93, No 7 (2022)
Research paper
Published online: 2022-04-05
Get Citation

Comparative analysis of classical primary continuous and novel technique uterine suturing methods on uterine scar formation after caesarian section: a prospective clinical study

Ugur Erkayiran1, Tufan Arslanca2
·
Pubmed: 35419795
·
Ginekol Pol 2022;93(7):552-557.
Affiliations
  1. Department of Obstetrics and Gynecology, Sutcu Imam University, Faculty of Medicine, Kahramanmaras, Turkey, Türkiye
  2. Department of Obstetrics and Gynecology, Ankara Ufuk University Faculty of Medicine Çankaya, Ankara, Turkey, Türkiye

open access

Vol 93, No 7 (2022)
ORIGINAL PAPERS Obstetrics
Published online: 2022-04-05

Abstract

Objectives:  The study investigated isthmocele rate, residual myometrium thickness, blood loss, and closure lengths through comparing the classical primary continuous suturing (CPCS) and novel technique uterine suturing (NTUS) after caesarian section.

Material and methods: A total of 402 C/S patients were included in this single-center prospective clinical study. All patients were divided into two groups according to suture technique. Classical primary continuous suturing (CPCS) was applied to the patients in Group 1, while the novel technique uterine suturing (NTUS) was applied in Group 2 as Z suture on both corners and 8 sutures in the remaining middle part incision closure.

Results: Patients in the NTUS group bled less than in the CPCS groups (p < 0.0001). Incision length after closure was longer in the CPCS than in the NTUS (p < 0.0001). Similarly, the number of sutures we applied was higher in the CPCS (p < 0.0001). In comparison of residual myometrium thickness, the mean values measured 197 ± 50 mm in the NTUS and 146 ± 39 mm in the CPCS (p < 0.0001). Residual myometrium thickness showed a negative strong correlation with incision length after closure (r = –0.436; p < 0.0001), how many times the needles have been passed (r = –0.423; p < 0.0001) and time for suturing (r = –0.237; p < 0.0001). NTUS and CPCS groups were similar in comparison to isthmocele.

Conclusions: The NTUS, termed as Erkayiran’s suture, showed a successful reflection in our surgical cesarean section application compared to the classical suture. Although the occurrence of isthmocele in patients was similar, results were quite successful operationally in terms of both minimal blood loss and increased residual myometrium thickness.

Abstract

Objectives:  The study investigated isthmocele rate, residual myometrium thickness, blood loss, and closure lengths through comparing the classical primary continuous suturing (CPCS) and novel technique uterine suturing (NTUS) after caesarian section.

Material and methods: A total of 402 C/S patients were included in this single-center prospective clinical study. All patients were divided into two groups according to suture technique. Classical primary continuous suturing (CPCS) was applied to the patients in Group 1, while the novel technique uterine suturing (NTUS) was applied in Group 2 as Z suture on both corners and 8 sutures in the remaining middle part incision closure.

Results: Patients in the NTUS group bled less than in the CPCS groups (p < 0.0001). Incision length after closure was longer in the CPCS than in the NTUS (p < 0.0001). Similarly, the number of sutures we applied was higher in the CPCS (p < 0.0001). In comparison of residual myometrium thickness, the mean values measured 197 ± 50 mm in the NTUS and 146 ± 39 mm in the CPCS (p < 0.0001). Residual myometrium thickness showed a negative strong correlation with incision length after closure (r = –0.436; p < 0.0001), how many times the needles have been passed (r = –0.423; p < 0.0001) and time for suturing (r = –0.237; p < 0.0001). NTUS and CPCS groups were similar in comparison to isthmocele.

Conclusions: The NTUS, termed as Erkayiran’s suture, showed a successful reflection in our surgical cesarean section application compared to the classical suture. Although the occurrence of isthmocele in patients was similar, results were quite successful operationally in terms of both minimal blood loss and increased residual myometrium thickness.

Get Citation

Keywords

caesarian section; uterine scar; isthmocele; suturing method; residual myometrium

About this article
Title

Comparative analysis of classical primary continuous and novel technique uterine suturing methods on uterine scar formation after caesarian section: a prospective clinical study

Journal

Ginekologia Polska

Issue

Vol 93, No 7 (2022)

Article type

Research paper

Pages

552-557

Published online

2022-04-05

Page views

4287

Article views/downloads

733

DOI

10.5603/GP.a2022.0022

Pubmed

35419795

Bibliographic record

Ginekol Pol 2022;93(7):552-557.

Keywords

caesarian section
uterine scar
isthmocele
suturing method
residual myometrium

Authors

Ugur Erkayiran
Tufan Arslanca

References (25)
  1. Simsek D, Urun C, Altekin Y. Determinants of cesarean-related complications: high number of repeat cesarean, operation type or placental pathologies? J Matern Fetal Neonatal Med. 2021; 34(22): 3768–3774.
  2. Sholapurkar SL. Etiology of cesarean uterine scar defect (Niche): detailed critical analysis of hypotheses and prevention strategies and peritoneal closure debate. J Clin Med Res. 2018; 10(3): 166–173.
  3. Laganà AS, Cromi A, Tozzi R, et al. Uterine scar healing after cesarean section: managing an old surgery in an evidence-based environment. J Invest Surg. 2019; 32(8): 770–772.
  4. Setúbal A, Alves J, Osório F, et al. Demonstration of isthmocele surgical repair. J Minim Invasive Gynecol. 2021; 28(3): 389–390.
  5. Tanos V, Toney ZA. Uterine scar rupture - Prediction, prevention, diagnosis, and management. Best Pract Res Clin Obstet Gynaecol. 2019; 59: 115–131.
  6. Stegwee SI, Jordans IPM, van der Voet LF, et al. Single- versus double-layer closure of the caesarean (uterine) scar in the prevention of gynaecological symptoms in relation to niche development - the 2Close study: a multicentre randomised controlled trial. BMC Pregnancy Childbirth. 2019; 19(1): 85.
  7. Schwickert A, Henrich W, Braun T. Uterine scar thickness as an important outcome for the evaluation of up-to-date uterine closure techniques. Am J Obstet Gynecol. 2018; 219(6): 632.
  8. Kalem Z, Kaya AE, Bakırarar B, et al. An optimal uterine closure technique for better scar healing and avoiding isthmocele in cesarean section: A randomized controlled study. J Invest Surg. 2021; 34(2): 148–156.
  9. Guan Z, Liu J, Bardawil E, et al. Surgical management of cesarean scar defect: the hysteroscopic-assisted robotic single-site technique. J Minim Invasive Gynecol. 2020; 27(1): 24–25.
  10. Chen H, Wang H, Zhou J, et al. Vaginal repair of cesarean section scar diverticula diagnosed in non-pregnant women. J Minim Invasive Gynecol. 2019; 26(3): 526–534.
  11. Fleisher J, Khalifeh A, Pettker C, et al. Patient satisfaction and cosmetic outcome in a randomized study of cesarean skin closure. J Matern Fetal Neonatal Med. 2019; 32(22): 3830–3835.
  12. Dokuzeylul Gungor N, Gurbuz T, Ture T. Prolonged luteal phase support with progesterone may increase papules and plaques of pregnancy frequency in pregnancies through in vitro fertilization. An Bras Dermatol. 2021; 96(2): 171–175.
  13. Bamberg C, Dudenhausen JW, Bujak V, et al. A prospective randomized clinical trial of single vs. double layer closure of hysterotomy at the time of cesarean delivery: the effect on uterine scar thickness. Ultraschall Med. 2018; 39(3): 343–351.
  14. Sevket O, Takmaz T, Ozcan P, et al. Hydrosonographic assessment of the effect of two different suture materials on healing of the uterine scar after cesarean delivery: A prospective randomized controlled trial. Z Geburtshilfe Neonatol. 2021; 225(2): 140–145.
  15. Park IY, Kim MR, Lee HN, et al. Risk factors for Korean women to develop an isthmocele after a cesarean section. BMC Pregnancy Childbirth. 2018; 18(1): 162.
  16. Woźniak A, Pyra K, Tinto HR, et al. Ultrasonographic criteria of cesarean scar defect evaluation. J Ultrason. 2018; 18(73): 162–165.
  17. Samy El-Agwany A. Considerations and variations in cesarean delivery techniques: A surgeon's view. Eur J Obstet Gynecol Reprod Biol. 2019; 239: 69–72.
  18. Akdemir A, Sahin C, Ari SA, et al. Determination of isthmocele using a foley catheter during laparoscopic repair of cesarean scar defect. J Minim Invasive Gynecol. 2018; 25(1): 21–22.
  19. Başbuğ A, Doğan O, Ellibeş Kaya A, et al. Does suture material affect uterine scar healing after cesarean section? Results from a randomized controlled trial. J Invest Surg. 2019; 32(8): 763–769.
  20. Jainer AK, Onalaja OA. Consolidated standard of reporting trials guidelines. Am J Psychiatry. 2003; 160(1): 191–2; author reply 192.
  21. Gürbüz T, Okçu NT. Charecteristics of postcesarean section pain. Journal of Health Sciences and Medicine. 2021; 4(1): 1–6.
  22. Vervoort AJ, Uittenbogaard LB, Hehenkamp WJK, et al. Why do niches develop in Caesarean uterine scars? Hypotheses on the aetiology of niche development. Hum Reprod. 2015; 30(12): 2695–2702.
  23. Yasmin S, Sadaf J, Fatima N. Impact of methods for uterine incision closure on repeat caesarean section scar of lower uterine segment. J Coll Physicians Surg Pak. 2011; 21(9): 522–526.
  24. Tulandi T, Cohen A. Emerging manifestations of cesarean scar defect in reproductive-aged women. J Minim Invasive Gynecol. 2016; 23(6): 893–902.
  25. Abalos E, Addo V, Brocklehurst P, et al. CORONIS collaborative group, CORONIS Collaborative Group. Caesarean section surgical techniques (CORONIS): a fractional, factorial, unmasked, randomised controlled trial. Lancet. 2013; 382(9888): 234–248.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., ul. Świętokrzyska 73, 80–180 Gdańsk
tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl