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Cesarean Delivery
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
A. Dhanya Mackeen, Meike Schuster
Skin incision techniques for CD have been evaluated separately from other aspects of CD in limited studies [122, 123]. In general, a transverse skin incision is recommended, since this is associated with less postoperative pain and improved cosmesis compared with a vertical incision. The Pfannenstiel (slightly curved, 2–3 cm or 2 fingerbreadths above the symphysis pubis, with the midportion of the incision lying within the shaved area of the pubic hair) and Joel-Cohen (straight, 3 cm below the line joining the anterior superior iliac spines, slightly more cephalad than the Pfannenstiel) are the preferred transverse incisions. Most RCTs do not only evaluate type of skin incision but also other technical aspects of CD, making it often impossible to evaluate the effect of only the type of skin incision [124]. The better designed, larger trial revealed no differences in total operative time (32 versus 33 minutes), intra- and postoperative complications, and neonatal outcomes, with the extraction time 50 seconds shorter for the Joel-Cohen group [122]. In contrast, a smaller study [123] showed significantly shorter operating times, reduced blood loss, and postoperative discomfort associated with the Joel-Cohen incision compared with the Pfannenstiel incision [125]. Considering the absence of clinical benefits to the mother and fetus, there is no clear indication for preferring either a Pfannenstiel or a Joel-Cohen incision for CD.
Abdominal surgery: General principles of access
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Nigel J. Hall, Katherine A. Barsness
The Pfannenstiel incision* is a lower abdominal incision that provides access to the pelvic organs, in particular the bladder, uterus, and ovaries, and results in a cosmetically acceptable scar. Depending on the degree of access required, division of the rectus muscles may be avoided completely.
Approach to one or more second-trimester painless abortions
Published in Minakshi Rohilla, Recurrent Pregnancy Loss and Adverse Natal Outcomes, 2020
A Pfannenstiel incision is given and abdominal layers opened. A transverse incision of the vesicouterine peritoneum is performed for bladder retraction. A Mersilene suture through the broad ligament close to the cervical stroma is taken all around, similar to the McDonald stitch, and tied securely.
Pedunculated sigmoid lipoma causing colo-colonic intussusception
Published in Baylor University Medical Center Proceedings, 2021
Kenneth Ford, Samantha Lopez, Gaurav Synghal, Yomi Fayiga, Brittany Carter, Anuj Kandel, Kenneth Ford
A 52-year-old man presented to his primary care physician after 2 weeks of abdominal pain and hematochezia. Computed tomography (CT) revealed a fat-containing sigmoid mass with colo-colonic intussusception (Figure 1a). The patient was instructed to go to the emergency department, where he complained of progressive 8/10 cramping left lower quadrant abdominal pain with signs of guarding. A complete blood count demonstrated a normal hemoglobin of 14.2 g/dL and a carcinoembryonic antigen <0.5 ng/mL. The patient’s body mass index was 31.4 kg/m2. A colonoscopy identified a large partially obstructing mass in the proximal sigmoid colon measuring 4 cm (Figure 1b). A tattoo was placed proximal and distal to the mass for surgical planning. Due to potential malignancy concerns, the partially obstructive nature of the lesion, and patient symptomatology, an elective laparoscopic partial sigmoidectomy was scheduled. The specimen was extracted through a Pfannenstiel incision (Figure 1c). The patient’s postoperative course was routine, and he was discharged home on postoperative day 2. Pathologic evaluation of the surgical specimen confirmed a pedunculated, submucosal colonic lipoma (Figure 1d).
Impact of timing on wound dressing removal after caesarean delivery: a multicentre, randomised controlled trial
Published in Journal of Obstetrics and Gynaecology, 2021
Gokhan Sami Kilic, Erhan Demirdag, Mehmet Fatih Findik, Omer Lutfi Tapisiz, Muhammet Erdal Sak, Orhan Altinboga, Sibel Sak, Bekir Serdar Unlu, Mehmet Siddik Evsen, Burak Zeybek, Mostafa Borahay, Yong-Fang Kuo
All operations were carried out using a similar technique. A single-dose intravenous antibiotic prophylaxis was administered to all women within 60 minutes before incision. Abdominal preparation in all caesareans was done by 2% Chlorhexidine Gluconate Cloth (Sage Products, Cary, IL) followed by 2% chlorhexidine gluconate/70% isopropyl alcohol (CHG/IPA) skin preparation solution (BD, Franklin Lakes, NJ). Pfannenstiel incision was performed in all of the operations. Intraoperatively, intraabdominal adhesion barriers were not used. Rectus muscle, bladder flap, and parietal peritoneum were not closed in all patients. Polyglactin 910 (Vicryl, Ethicon, Somerville, NJ) or polydioxanone (PDO, PDS; Ethicon) were used for fascia closure in all CDs. If subcutaneous depth was more than 2 cm, an approximation of tissue with 2-0 Vicryl (Ethicon) was used. Monocryl 2-0 (Ethicon) was used for subcuticular closure of skin incisions. The incisions were covered with telfa (Covidien, MA). Ten 4 × 4 gauze pads opened to a size of 8 × 4 were folded lengthwise and placed over the telfa, and then covered with perforated soft cloth surgical tape (3 M Medipore, MN) under a slight tension.
Placenta accreta spectrum disorder: a comparison between fertility-sparing techniques and hysterectomy
Published in Journal of Obstetrics and Gynaecology, 2021
Hüseyin Durukan, Ömer Birol Durukan, Faik Gürkan Yazıcı
The pre-operative PAS diagnoses were based on the loss of the clear zone, presence of placental lacunae, and interruption of the bladder-uterus border according to grey-scale ultrasonography (USG), and increased vascularity in this area based on Doppler USG (Figure 1(A)). The diagnoses were confirmed intra-operatively, and the patients with severe PAS underwent further exploration. In our clinic, most patients underwent a Pfannenstiel incision that was followed by a transverse uterine incision at the upper border of the placental insertion. A diagnosis of slight and mild PAS was confirmed if the placenta adhered firmly to the myometrium, which caused difficulties when detaching the placenta manually, and if the bleeding persisted after manual and instrumental scraping of the placenta (Figure 1(B)). Haemostatic interventions, including uterine artery ligation (UAL) or bilateral internal iliac artery ligation (IIAL) were applied, as required. Patients with coagulation disorders were excluded from the analysis.