ABSTRACT We aimed to show that extraperitoneal cesarean delivery (EPCD) is more advantageous than trans peritoneal cesarean delivery (TPCD). Sixty cases analyzed either EPCD or TPCD were included in this study. Patients with suspected placental invasion anomalies (placenta accreta, increta or percreta), placenta previa, a history of midline uterine incision, multiple pregnanci es, previous cesarean section, previous major abdominal surgery, delivery before 34 weeks of gestation or fetal macrosomia (estimated fetal weight >4500 g) were excluded. The endpoints were the duration of the operation, nausea and vomiting during the operation, postoperative nausea and vomiting, the number of an algesic medications, postoperative shoulder pain, postoperative gas/stool discharge time, complete blood count (CBC), urinary dysfunction, and neonatal outcomes. Results TPCD patients suffered significantly more intraoperative nausea (10% vs. 33.3%, p:0.03) and postoperative vomiting (0% vs. 13.3%, p: 0.04) compared to TPCD group. There was no significant difference in intraoperative vomiting and postoperative nausea rates between the two groups (p: 0,282). The duration of the operation was shorter in TPCD than EPCD groups (25,5 minutes vs. 28,7 minutes, p=0.01). After the operation, significantly fewer analgesic drugs were used in the EPCD than the TPCD groups (p: 0.01). The duration between defecation and operation was significantly shorter in the EPCD group compared to TPCD group (p: 0,042). Postoperative shoulder pain and flatulating time were similar between the two groups. There was no significant difference in urinary symptoms after six weeks of the operation between the two groups (p:0,690). No significant difference was found for neonatal outcomes between each groups. EPCD reduces postoperative pain, analgesic requirement, nausea, vomiting, and bowel dysfunction in cesarean patients without an increase in significant complications.
___
1. Martin JA, Hamilton BE, Osterman MJ, Driscoll AK. Births: Final data for 2018. Natl Vital Stat Rep 2019; 68: 1.
2. Gibbons L, Belizán J, Lauer J, et al. The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. World Health Rep 2010; 2010: 30.
3. Martin JA, Hamilton BE, Osterman MJK, et al. Births: final data 2017. Natl Vital Stat Rep 2018; 67: 1-55.
4. Gedikbasi A, Akyol A, Ulker V, et al. Cesarean techniques in cases with one previous cesarean delivery: comparison of modified MisgavLadach and Pfannenstiel–Kerr. Arch Gynecol Obstet 2011; 283: 711-716.
5. Seiler CM, Deckert A, Diener MK, et al. Midline versus transverse incision in major abdominal surgery: a randomized, doubleblind equivalence trial. Ann Surg 2009; 249: 913.
6. Brown S, & Tiernan J. Transverse verses midline incisions for abdominal surgery. Cochrane Database of Systematic Reviews 2005.
7. Bickenbach KA, Karanicolas PJ, Ammori JB, et al. Up and down or side to side? A systematic review and meta-analysis examining the impact of incision on outcomes after abdominal surgery. Am J Surg 2013; 206: 400.
8. Latzko W. Der extraperitoneale Kaiserschnitt. Wien Klin Wochenschr 1909; 22: 478- 482.
9. Wallace RL, Eglinton GS, Yonekura ML, et al. Extraperitoneal cesarean section: a surgical form of infection prophylaxis? Am J Obstet Gynecol 1984; 148: 172-177.
10. Hanson HB. Current use of the extraperitoneal cesarean section: a decade of experience. Am J Obstet Gynecol 1984; 149: 31-34.
11. Zabransky F, Grossmannova H. Extraperitoneal cesarean section ean alternative or routine? Ceska Gynekol 2001; 66: 1887-1889.
12. Zabransky F. Somer ecen observations on the extraperitoneal cesarean section. Zentralbl Gynakol 1985; 107: 574-576.
13. Tappauf C, Schest E, Reif P, et al. Extraperitoneal versus transperitoneal cesarean section: a prospective randomize comparison of surgical morbidity. Am J Obstet Gynecol 2013; 209: 338.e1
14. Yeşilbaş C, Erenel H. Extraperitoneal versus transperitoneal cesarean section: a retrospective analysis. Perinatal Journal 2017; 25: 38-42.
15. Tulandi T, Agdi M, Zarei A, et al. (2009). Adhesion development and morbidity after repeat cesarean delivery. Am J of Obstetand Gynecol 2009; 201: 56.e1:56.e6.
16. Guangyou Duan, Guiying Yang, Jing Peng, et al. Comparison of postoperative pain between patients who underwent primary and repeated cesarean section: a prospective cohort study. BMC Anesthesiol 2019; 19: 189.
17. Shumaker SA, Wyman JF, Uebersax JS, et al. Health-related quality of life measures for women with urinary incontinence: the incontinence impact questionnaire and the urogenital distress inventory; continence program in women (CPW) research group. Qual Life RES 1994; 3: 291-206.
18. Bjelic-Radisic V, Dorfer M, Tamussino K, et al. The incontinence outcome questionnaire: an instrument for assessing patient-reported outcomes after surgery for stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunction 2007; 18: 1139-1149.
19. Cacciarelli RA. Extraperitoneal cesarean section; a new paravesical approach. Am J Surg 1949; 78: 371-373.
20. Norton JF. A paravesical extraperitoneal cesarean section technique; with an analysis of 160 paravesical extraperitoneal cesarean sections. Am J Obstet Gynecol 1946; 51: 519- 526.
21. Fauck M. Ambulatory cesarean section, 2009. http://www.youtube.com/ watch?v1⁄4dvCXhQU0eqE&feature1⁄4youtube _gdata_player Access date 06.12.2011
22. Hofmeyr JG, Novikova N, Mathai M, et al. Techniques for cesarean section. Am J Obstet Gynecol 2009; 201: 431-444.
23. Chou CY, Liang PC, Chen CA, et al. Cervical abscess with vaginal fistula after extraperitoneal cesarean section. J Formos Med Assoc 2007; 106: 1048-1051.
24. Mokgokong ET, Crichton D. Extraperitoneal lower segment cesarean section for infected cases: a reappraisal. S Afr Med J 1974; 48: 788-790.
25. Suharwardy, Sanaa, Carvalho, et al. Brendan Enhanced recovery after surgery for cesarean delivery. Current Opinion in Obstetrics and Gynecology 2020; 32: 113-120