CORONIS - International study of caesarean section surgical techniques: the follow-up study (original) (raw)
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Extraabdominal vs intraabdominal uterine repair at cesarean delivery: a metaanalysis
American Journal of Obstetrics and Gynecology, 2009
This review compared extra-abdominal and intra-abdominal uterine repair on perioperative complications following caesarean delivery. The authors concluded that method of repair did not appear to influence the rate of perioperative complications. Potential selection bias, uncertainties in the review process and unclear study quality, made the extent to which the authors' conclusion can be relied upon unclear. Authors' objectives To compare extra-abdominal and intra-abdominal uterine repair after caesarean delivery. Searching MEDLINE and The Cochrane Library were searched for published English-language articles. Search dates ranged from 1958 to June 2008. Study selection Randomised controlled trials (RCTs) of extra-abdominal (exteriorised) versus intra-abdominal (in situ) uterine repair after caesarean delivery were eligible for inclusion in the review. Retrospective studies were excluded. Trials included in the meta-analysis had to report at least one clinical endpoint from the primary outcomes of interest: perioperative complications, which included intraoperative (nausea and vomiting, hypotension, and pain) and postoperative complications (endometritis, febrile morbidity, wound infection, venous thromboembolism, pain, need for blood transfusion, and maternal death). Secondary outcomes of interest were operative time, estimated blood loss in milliliters and hospital stay. The authors reported that there were no differences in baseline characteristics of the included trials. The authors stated neither how the papers were selected for the review nor how many reviewers performed the selection. Methods of synthesis Summary estimates and 95% CIs were pooled in a meta-analysis. The Cochran Q test was used to assess statistical heterogeneity. Results of the review Eleven RCTs (n=3,183) were included in the meta-analysis. There were 1,605 women in the exteriorised group, and 1,578 women in the in situ group. Quality assessment results were not reported. There were no significant differences between groups in terms of postoperative or intraoperative complications, operative time and estimated blood loss. The rate of endometritis was higher in the exteriorised group, but this was not statistically significant and was based on heterogeneous data (p=0.02). Statistical heterogeneity was also reported for the outcomes of operative time and hospital stay, but results were not presented. Two maternal deaths were reported in the exteriorised group, but the risk was not statistically significant.
Effects of method of uterine repair on surgical outcome of cesarean delivery
International Journal of Gynecology & Obstetrics, 2010
Objective: To compare the rates of intraoperative and postoperative complications of uterine repair when performed in situ or extra-abdominally following cesarean delivery. Methods: In this prospective randomized study 4925 women who underwent cesarean delivery were randomly assigned to in situ (n = 2462) or extraabdominal (n = 2463) uterine repair (group 1 and group 2, respectively). The study compares drop in hemoglobin concentration (as a measure of intraoperative blood loss). It also compares operating time, time to return of bowel sound, and duration of hospitalization as well as rates of uterine atony, blood transfusion, intraoperative complications, additional use postoperative analgesics, endometritis, and wound infection. Results: Uterine atony developed in 96 women (3.8%) in group 1 and 226 women (9.1%) in group 2 (P = 0.001). Moreover, the operating time and the time to return of bowel sound were shorter and the rates of both additional use of postoperative analgesics and wound infection were lower in group 1 (P = 0.001, P = 0.002, P = 0.001, and P = 0.003, respectively). Conclusion: Fewer cases of uterine atony, a shorter operating time, a faster return of bowel function, a lesser need for postoperative analgesics, and lower rates of additional use of postoperative analgesics and wound infections suggest that in-situ uterine repair ought to be preferred to extra-abdominal uterine repair following cesarean delivery.
Sultan Qaboos University Medical Journal, 2014
(NHS), as a share of national income, has more than doubled, rising by an average of 4% a year in real terms. This period of rapid growth has now ended, but funding pressures on the NHS continue to rise igniting a debate on the most cost-effective way of offering treatment. In this context, we audited subtotal abdominal hysterectomy (STAH) and laparoscopic-assisted supra-cervical hysterectomy (LASH) for benign gynaecological indications in a large district general hospital. A retrospective audit was undertaken of records of patients who had STAH or LASH for benign conditions at Wishaw General Hospital between August and July 2012. Twenty-five patients for each procedure were identified from the theatre information system. As three sets of notes could not be traced, there were 22 patients in the STAH group and 25 in LASH group. The mean operating time for STAH was 61 min (34-85 min) and 145 min (75-237 min) for the LASH group. There was one major complication in the STAH group (1,000 ml blood loss) compared to five in the LASH group (a pelvic infection, two wound infections and two patients with neuropathic pain at port sites). The mean hospital stay in the STAH group was 2.5 nights (2-4 nights) and 2 nights for patients undergoing LASH (1-4 nights). Costs were £2,213.40 (= OMR 1420) for STAH and £2,613.80 (= OMR 1677) for LASH. In this study, complication rates and apparent costs seemed comparable. Shorter hospital stays and possibly quicker recovery are areas where the laparoscopic approach scores over open surgery. In days of austerity for the NHS, surgery options need careful consideration. Open surgery's shorter operating times will help tackle long waiting lists but, if the impact on post-operative recovery and time off work are considered, the laparoscopic approach might be better.
BMC Pregnancy and Childbirth, 2007
Background Caesarean section is one of the most commonly performed operations on women throughout the world. Rates have increased in recent years – about 20–25% in many developed countries. Rates in other parts of the world vary widely. A variety of surgical techniques for all elements of the caesarean section operation are in use. Many have not yet been rigorously evaluated in randomised controlled trials, and it is not known whether any are associated with better outcomes for women and babies. Because huge numbers of women undergo caesarean section, even small differences in post-operative morbidity rates between techniques could translate into improved health for substantial numbers of women, and significant cost savings. Design CORONIS is a multicentre, fractional, factorial randomised controlled trial and will be conducted in centres in Argentina, Ghana, India, Kenya, Pakistan and Sudan. Women are eligible if they are undergoing their first or second caesarean section through a...
Uterine exteriorization versus intraperitoneal repair at caesarean section
Reviews, 1996
Purpose: The aim of this study is to evaluate the effect of uterine exteriorization versus intraperitoneal repair, in first compared to repeat cesarean delivery. Methods: A prospective randomized control single-blinded trial conducted in a single tertiary center between March 2014 and March 2015, including 32 and 63 women in first and recurrent cesarean sections, respectively. Inclusion criteria were elective operation and gestational age 37 weeks. Operative outcomes were compared between the groups including mean operative time, blood loss, hypotension, perioperative nausea and pain. Post-operative outcomes were further compared, including post-operative analgesia demand, first recognized bowel movement, nausea, length of hospital stay, fever, endometritis surgical site infection rate, and total satisfaction. Results: During the study period, 45 and 50 women were designated for uterine exteriorization and intraperitoneal uterine repair, respectively. Mean blood loss was 452 cc (±10.44) for the extraperitoneal compared to 540 cc (±29.83) for the intraperitoneal uterine repair group (p ¼ .004). No other significant differences in either intraoperative or postoperative complications were demonstrated in and between the groups. Conclusion: Intraperitoneal repair of uterine incision is associated with higher operative blood loss compared to uterine exteriorization. No other differences in operative and postoperative complication rates were found between the groups.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2018
Background: Caesarean section is a commonest surgical procedure performed by an obstetrician. Many variations in technique of caesarean section have been devised with the intent of shortening the operating time, making the operation easier, safer and more efficient; and to decrease the blood loss, postoperative morbidity, other complications as well as to shorten the period of hospitalization. One such variation is in the technique of repair of the uterus, whether it is repaired in situ or taken out from the incision and repaired outside the abdomen before replacing it back in place. This study was designed to compare two techniques of uterine closure and determine the benefit of using one technique over the other.Methods: A prospective observational study on 100 women who underwent caesarean section. Technique of uterine repair was surgeon dependent and was not influenced by investigator. Based on this, patients were assigned into two separate groups (exteriorised group and in sit...
Perinatal Journal, 2017
Geçirilmifl sezaryeni olan hastalarda uterus insizyonunun transvers veya sefalokaudal geniflletilmesinin sonuçlar›: Prospektif randomize kontrollü çal›flma Amaç: Daha önce sezaryen operasyonu geçirmifl hastalarda sezaryen s›ras›nda uterusa uygulanan insizyonunun transvers veya sefalokaudal yönde geniflletilmesinin intraoperatif ve postoperatif so-nuçlar›n›n karfl›laflt›r›lmas›. Yöntem: Prospektif randomize kontrollü çal›flmam›zda, hastanemizde Temmuz 2014-Haziran 2015 tarihleri aras›nda, tekrarlayan sezaryen endikasyonuyla sezaryen yap›lan hastalar uterus insizyonunun sefalokaudal veya transvers olarak geniflletilmesine göre iki gruba ayr›ld›. Çal›flmaya dahil edilen tüm hastalar›n demografik özellikleri, intraoperatif ve postoperatif verileri kaydedildi. Elde edilen istatistik verileri ile birlikte uterus insizyonunun sefalokaudal veya transvers geniflletilmesi aras›ndaki farkl›l›klar de¤erlendirildi. Bulgular: Her iki grup aras›nda kanama miktar›, transfüzyon ihti-yac›, uterin arter hasar›, mesane hasar›, atoni geliflmesi aç›s›ndan istatistiksel aç›dan anlaml› fark saptamad›k. Kerr insizyonu sefalokaudal geniflletilenlerde transvers gruba göre insizyon hatt›nda uzamay› anlaml› oranda düflük bulduk (p<0.05). Bu duruma ba¤l› olarak ek sütür gereksinimini anlaml› olarak daha az saptad›k (p<0.05). Sonuç: Uterus insizyonu transvers geniflletilen grupta insizyon hatt›nda uzama ve ek sütür gereksinimini daha fazlad›r.