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The effect of suture materials with different absorption times on isthmocele: a retrospective study
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Affiliations- Obstetrics and Gynecology Clinic of the Başkent University Adana Dr. Turgut Noyan Research and Application Center, Adana, Türkiye
open access
Abstract
Objectives: With the increasing rate of cesarean operations, the formation of niches and related early and late complications have been observed more frequently. In this study, we examined the effects of using a suture material that can be absorbed faster than conventional sutures on the formation of niches.
Material and methods: This study was designed as a retrospective study and completed with a total of 101 patients. During the cesarean operation, the uterus was closed with Rapide Vicryl® in 49 patients and Vicryl® in 52 patients. The uterine niche was measured with a sonohysterogram 6 months after the operation. The primary outcome of the study was determined as uterine niche formation and the secondary outcome was the post-menstrual spotting (PMS) rate.
Results: Duration of surgery, intraoperative/postoperative blood loss, and hospitalization time were similar between the two groups. Niche formation was significantly lower in the Rapide Vicryl group (22.4%) when compared to the Vicryl group (42.3%) (p = 0.046). Also, PMS was observed significantly lower in the Rapide Vicryl group (16.2% and 52.8% in Rapide Vicryl and Vicryl groups, respectively; p = 0.002).
Conclusions: The formation of niches and associated PMS rates were less with suture materials that were absorbed faster.
Abstract
Objectives: With the increasing rate of cesarean operations, the formation of niches and related early and late complications have been observed more frequently. In this study, we examined the effects of using a suture material that can be absorbed faster than conventional sutures on the formation of niches.
Material and methods: This study was designed as a retrospective study and completed with a total of 101 patients. During the cesarean operation, the uterus was closed with Rapide Vicryl® in 49 patients and Vicryl® in 52 patients. The uterine niche was measured with a sonohysterogram 6 months after the operation. The primary outcome of the study was determined as uterine niche formation and the secondary outcome was the post-menstrual spotting (PMS) rate.
Results: Duration of surgery, intraoperative/postoperative blood loss, and hospitalization time were similar between the two groups. Niche formation was significantly lower in the Rapide Vicryl group (22.4%) when compared to the Vicryl group (42.3%) (p = 0.046). Also, PMS was observed significantly lower in the Rapide Vicryl group (16.2% and 52.8% in Rapide Vicryl and Vicryl groups, respectively; p = 0.002).
Conclusions: The formation of niches and associated PMS rates were less with suture materials that were absorbed faster.
Keywords
cesarean; Vicryl; Rapide Vicryl; isthmocele; niche; scar
About this articleTitle
The effect of suture materials with different absorption times on isthmocele: a retrospective study
Journal
Issue
Article type
Research paper
Pages
897-902
Published online
2023-06-12
Page views
534
Article views/downloads
327
DOI
Pubmed
Bibliographic record
Ginekol Pol 2023;94(11):897-902.
Keywords
cesarean
Vicryl
Rapide Vicryl
isthmocele
niche
scar
Authors
Selcuk Yetkinel
Pinar Caglar Aytac
Hakan Kalayci
Tayfun Cok
Gulsen Dogan Durdag
Didem Alkas Yaginc
Safak Yilmaz Baran
Songul Alemdaroglu
Esra Bulgan Kilicdag
References (18)- Bamberg C, Hinkson L, Henrich W. Cesarean scar niche and uterotomy closure technique. Acta Obstet Gynecol Scand. 2018; 97(5): 630.
- Piriyev E, Schiermeier S, Römer T. Laparoscopic Isthmocele (Niche) Correction as prevention in patients with fertility desire. Ginekol Pol. 2022; 93(12): 954–961.
- Kremer T, Ghiorzi I, Dibi R. Isthmocele: an overview of diagnosis and treatment. Kremer TG, Ghiorzi IB, Dibi RP. Isthmocele: an overview of diagnosis and treatment. Revista da Associação Médica Brasileira. 2019;65(5):714-21. 2019; 65(5): 714–721.
- 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.
- Smit IB, Witte E, Brand R, et al. Tissue reaction to suture materials revisited: is there argument to change our views? Eur Surg Res. 1991; 23(5-6): 347–354.
- Başbuğ A, Doğan O, Kaya AE, et al. Does suture material affect uterine scar healing after cesarean section? Results from a randomized controlled trial. J Invest Surg. 2018; 32(8): 763–769.
- Tabachnick BG, Fidell LS. Using Multivariate Statistics. 6th ed. Pearson, Boston 2013.
- Voet LFv, Vaate AMB, Veersema S, et al. Long-term complications of caesarean section. The niche in the scar: a prospective cohort study on niche prevalence and its relation to abnormal uterine bleeding. BJOG. 2014; 121(2): 236–244.
- Budny-Winska J, Pomorski M. Uterine niche after cesarean section: a review of diagnostic methods. Ginekol Pol. 2021; 92(10): 726–730.
- Roberge S, Demers S, Berghella V, et al. Impact of single- vs double-layer closure on adverse outcomes and uterine scar defect: a systematic review and metaanalysis. Am J Obstet Gynecol. 2014; 211(5): 453–460.
- Sardo AD, Saccone G, McCurdy R, et al. 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(5): 578–583.
- Baran ŞY, Kalaycı H, Durdağ GD, et al. Single‐ or double‐layer uterine closure techniques following cesarean: A randomized trial. Acta Obstet Gynecol Scand. 2020; 100(3): 531–537.
- 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.
- Ceci O, Cantatore C, Scioscia M, et al. Ultrasonographic and hysteroscopic outcomes of uterine scar healing after cesarean section: comparison of two types of single-layer suture. J Obstet Gynaecol Res. 2012; 38(11): 1302–1307.
- 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.
- Doillon CJ, Dunn MG, Bender E, et al. Collagen fiber formation in repair tissue: development of strength and toughness. Coll Relat Res. 1985; 5(6): 481–492.
- Wojdecki J, Grynsztajn A. Scar formation in the uterus after cesarean section. Am J Obstet Gynecol. 1970; 107(2): 322–324.
- David LD. Ethicon Wound Closure Manual. Somerville, New Jersey 2004: 10–19.
