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

Abstract

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.

Keywords:

• Caesarean section
• mass closure
• visceral peritoneum
• bladder flap
• vesicouterine space
• complications
• dystocia
• obstetric

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.