Mass closure of visceral peritoneum at cesarean section. A proposal method. 2010

Antonio Malvasi, and Andrea Tinelli, and Elena Pacella
Department of Obstetrics and Gynaecology, Santa Maria Hospital, Bari, Italy. antoniomalvasi@gmail.com

The non-closure of the visceral peritoneum (VP) is the gold standard in caesarean section (CS). For surgeons convinced of the benefits of VP closuring, we propose an alternative method for VP closure during CS, named by us, "Mass Closure Method" (MCM). According to our experience, this method has already been experimented, as described earlier, in 314 CSs in loco-regional anaesthesia. All CSs in our department are performed using the modified Joel Cohen incision in the Stark CS, with the Munro Kerr way of hysterotomy. During haemostasis in 18 cases, author observed a small sub-peritoneal haematoma (5.7%), solved intra-operatively by singular stitches; 10 women received a bladder flap intraoperative detachment, with an accurate haemostasis (3.1%). No case of bladder flap haematoma was recorded, but only hyperechogenic areas in the vesicouterine space (VUS), to be ascribed to the intra-operatives stitches. The direct incision, no bladder flap formation and not suturing a part of the VP, substantially reduce the VUS surface, consequently decrease bleeding, and prevent a pouch formation. On the basis of the author's experiences, the MCM could represent for obstetrics a safe alternative to the surgical approach during CS, as it cut down operative time, surgical bleeding, BHF formation for the non-bladder flap formation, thus reducing the VUS surface.

UI MeSH Term Description Entries
D007431 Intraoperative Complications Complications that affect patients during surgery. They may or may not be associated with the disease for which the surgery is done, or within the same surgical procedure. Peroperative Complications,Surgical Injuries,Complication, Intraoperative,Complication, Peroperative,Injuries, Surgical,Complications, Intraoperative,Complications, Peroperative,Injury, Surgical,Intraoperative Complication,Peroperative Complication,Surgical Injury
D010537 Peritoneum A membrane of squamous EPITHELIAL CELLS, the mesothelial cells, covered by apical MICROVILLI that allow rapid absorption of fluid and particles in the PERITONEAL CAVITY. The peritoneum is divided into parietal and visceral components. The parietal peritoneum covers the inside of the ABDOMINAL WALL. The visceral peritoneum covers the intraperitoneal organs. The double-layered peritoneum forms the MESENTERY that suspends these organs from the abdominal wall. Parietal Peritoneum,Peritoneum, Parietal,Peritoneum, Visceral,Visceral Peritoneum,Parametrium,Parametriums
D011247 Pregnancy The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH. Gestation,Pregnancies
D002585 Cesarean Section Extraction of the FETUS by means of abdominal HYSTEROTOMY. Abdominal Delivery,Delivery, Abdominal,C-Section (OB),Caesarean Section,Postcesarean Section,Abdominal Deliveries,C Section (OB),C-Sections (OB),Caesarean Sections,Cesarean Sections,Deliveries, Abdominal
D005260 Female Females
D006406 Hematoma A collection of blood outside the BLOOD VESSELS. Hematoma can be localized in an organ, space, or tissue. Hematomas
D006488 Hemostasis, Surgical Control of bleeding during or after surgery. Surgical Hemostasis,Hemostases, Surgical,Surgical Hemostases
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D013536 Suture Techniques Techniques for securing together the edges of a wound, with loops of thread or similar materials (SUTURES). Suture Technics,Suture Technic,Suture Technique,Technic, Suture,Technics, Suture,Technique, Suture,Techniques, Suture
D016063 Blood Loss, Surgical Loss of blood during a surgical procedure. Hemorrhage, Surgical,Surgical Blood Loss,Surgical Hemorrhage,Surgical Blood Losses,Surgical Hemorrhages

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