Abstract
Objectives: There is not yet a consensus on the optimal surgical technique for cesarean section. This is the first study comparing two different (Cesarean Section) with respect to the following inflammatory reaction in means of changes in inflammatory marker levels.To evaluate the differences in inflammatory reactions following two different (Cesarean Section) techniques, the modified Misgav-Ladach versus the Pfannenstiel-Kerr technique.Study Desıgn: The study population included 88 pregnant women who met the inclusion criteria. These women were randomized into two groups according to Consolidated Standards of Reporting Trials guidelines: Group 1 (Misgav-Ladach group) and Group 2 (Pfannenstiel Kerr group). To compare the inflammatory reactions following surgery, Interleukin-6 (IL-6) and Tumor Necrosis Factor-α (TNF-α) levels were measured in venous blood samples drawn from the patients just before (0 hour) and 24 hours (24th hour) after the surgery. In 5 women from Group 1 and 2 women from Group 2, the 24th hour blood samples could not be obtained or were lost. Thus, a total of 81 women, 39 women from Group 1 and 42 women from Group 2, comprised the population of study. The differences in inflammatory reactions between the 0 and 24th hours were analyzed by calculating the percent change in IL-6 and TNF-α levels, and these percentages were then compared between the groups.Results: There was a statistically significant difference between Group 1 and Group 2 regarding the serum IL-6 level change between 0 and 24th hour (530±653% and 196±168%, respectively, p=0.022. The difference in TNF-α was also higher in Group 2, but the difference was not statistically significant (229±306% vs. 571±824%, p=0.12). The mean operation time was significantly shorter in Group 1 (9.44 min. vs. 16.86 min, p=0.0001).Conclusions: The results of this study indicate that the modified Misgav-Ladach technique has a weaker inflammatory reaction, which indicates fewer short- and long-term surgical complications.
Highlights
Cesarean section (C/S) is the most common reason for laparotomy in women of childbearing age, there is not yet a consensus on the optimal surgical technique for cesarean section (C/S)
The difference in tumor necrosis factor-α (TNF-α) was higher in Group 2, but the difference was not statistically significant (229±306% vs. 571±824%, p=0.12)
The results of this study indicate that the modified Misgav-Ladach technique has a weaker inflammatory reaction, which indicates fewer short- and long-term surgical complications
Summary
Cesarean section (C/S) is the most common reason for laparotomy in women of childbearing age, there is not yet a consensus on the optimal surgical technique for C/S. The first well-defined C/S method, the Pfannenstiel-Kerr technique, which is defined as the “traditional cesarean technique” in the current literature, was the preferred C/S technique, especially in the second half of the 20th century [2]. Several modifications were made to this technique in terms of uterine, peritoneal, and skin closures, as well as skin and uterine incision types. The Misgav-Ladach method was defined by Stark et al by combining all previously reported modifications [3]. These two methods, the Pfannenstiel-Kerr and Misgav-Ladach methods, represent the two extremes of C/S surgery [1]
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