Abstract
The choice of the type of abdominal incision performed in caesarean delivery is made chiefly on the basis of the individual surgeon’s experience and preference. A general consensus on the most appropriate surgical technique has not yet been reached. The aim of this systematic review of the literature is to compare the two most commonly used transverse abdominal incisions for caesarean delivery, the Pfannenstiel incision and the modified Joel-Cohen incision, in terms of acute and chronic post-surgical pain and their subsequent influence in terms of quality of life. Electronic database searches formed the basis of the literature search and the following databases were searched in the time frame between January 1997 and December 2013: MEDLINE, EMBASE Sciencedirect and the Cochrane Library. Key search terms included: “acute pain”, “chronic pain”, “Pfannenstiel incision”, “Misgav-Ladach”, “Joel Cohen incision”, in combination with “Caesarean Section”, “abdominal incision”, “numbness”, “neuropathic pain” and “nerve entrapment”. Data on 4771 patients who underwent caesarean section (CS) was collected with regards to the relation between surgical techniques and postoperative outcomes defined as acute or chronic pain and future pregnancy desire. The Misgav-Ladach incision was associated with a significant advantage in terms of reduction of post-surgical acute and chronic pain. It was indicated as the optimal technique in view of its characteristic of reducing lower pelvic discomfort and pain, thus improving quality of life and future fertility desire. Further studies which are not subject to important bias like pre-existing chronic pain, non-standardized analgesia administration, variable length of skin incision and previous abdominal surgery are required.
Highlights
Caesarean section (CS) has become one of the most performed surgical procedures worldwide
We considered eligible all original descriptions, case series, and retrospective evaluations which compared or described outcomes concerning acute and/or chronic pain after CS
We considered eligibility criteria the availability of data regarding the following: type of CS incision (Pfannenstiel incision and/or Misgav-Ladach/Joel-Cohen incision) with the description of details concerning incision length, acute and chronic pain (VAS scale and timing of onset) type of CS as well as the standard epidemiological features of the patients involved in the studies
Summary
Caesarean section (CS) has become one of the most performed surgical procedures worldwide. Both in Italy and in the United States, CS rates have increased dramatically over the past decades. Several CS skin incision and abdominal wall opening techniques have been developed during the years, yet a general consensus on the most appropriate approach, in terms of safety and morbidity, has not been yet reached. Acute and chronic pain after CS depends mainly on the type of cutaneous incision and subsequent access into the pelvic cavity, in relation to the abdominal wall’s somatic innervation. Nerve injury or entrapment occurring during or following surgical procedures seems to be the main cause responsible for the occurrence of chronic pain after CS. Acute and chronic pain after CS depends mainly on the type of cutaneous incision and subsequent access into the pelvic cavity, in relation to the abdominal wall’s somatic innervation. [5] The evaluation of post-surgical wellbeing benefits from the use of subjective and objective pain scores in both early and long term follow-up.
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