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Updated: Dec 29, 2025
Laparoscopic Extracorporeal Knot-Tying for Uterine Vessel Occlusion during Hysterectomy with Cervical Cerclage in Large Uteri
Published on: September 12, 2025
Uterine exteriorization versus intraperitoneal repair in primary and repeat cesarean delivery: a randomized
Aya Mohr-Sasson1,2, Elias Castel1,2, Irina Lurie1
1Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel.
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 = .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.
