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Comparison between extraperitoneal and transperitoneal cesarean section: Retrospective case-control study.

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Extraperitoneal cesarean section (EXPCS) shows reduced infection and adhesions compared to transperitoneal cesarean section (TPCS). EXPCS offers a protective effect against infection and is beneficial for women undergoing repeat cesarean deliveries.

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Area of Science:

  • Obstetrics and Gynecology
  • Surgical Innovation
  • Patient Recovery Outcomes

Background:

  • Extraperitoneal cesarean section (EXPCS) offers potential benefits over traditional transperitoneal cesarean section (TPCS), including reduced pain, faster recovery, and lower infection risk.
  • A key advantage of EXPCS may be the prevention of intraperitoneal adhesions, a common complication of abdominal surgery.

Purpose of the Study:

  • To compare the outcomes of extraperitoneal cesarean section (EXPCS) with standard transperitoneal cesarean section (TPCS).
  • To evaluate the incidence of postoperative infection, pain, and intraperitoneal adhesions between the two cesarean section methods.

Main Methods:

  • A comparative study of 88 extraperitoneal cesarean sections (EXPCS) and 90 transperitoneal cesarean sections (TPCS) performed between 2019 and 2022.
  • Inclusion criteria focused on uterine inertia and prolonged labor, with final analysis including 51 EXPCS and 49 TPCS patients.
  • Outcomes assessed included operative time, newborn parameters, inflammatory markers (leukocytes, CRP), pain scores (VAS), analgesic use, and incidence of intraperitoneal adhesions.

Main Results:

  • No significant differences were observed in gestational age, newborn weight, Apgar scores, or operative time between EXPCS and TPCS groups.
  • TPCS group showed statistically significant higher levels of leukocytes, C-reactive protein (CRP), and fever on postoperative day 3 (p=0.005).
  • TPCS patients required significantly more analgesics (tramadol, metamizole, diclofenac) and reported higher pain scores (VAS) at 24 hours post-surgery (p=0.001).
  • Intraperitoneal adhesions were absent in patients who had TPCS after EXPCS, but present in 12 patients who underwent TPCS twice (p=0.04).

Conclusions:

  • Extraperitoneal cesarean section (EXPCS) demonstrates a protective effect against infection, particularly in cases of prolonged labor.
  • EXPCS is a promising approach for mitigating the risk of intraperitoneal adhesions and infection in women undergoing repeat cesarean sections.
  • The findings support EXPCS as a valuable alternative for specific patient populations, especially those with a history of multiple cesarean deliveries.