Reply to: Comparative evaluation of the Misgav Ladach cesarean section with two traditional techniques. The first four years’ experience

Abstract

Acta Obstetricia et Gynecologica ScandinavicaVolume 80, Issue 1 p. 91-91 Free Access Reply to: Comparative evaluation of the Misgav Ladach cesarean section with two traditional techniques. The first four years’ experience First published: 28 June 2008 https://doi.org/10.1111/j.1600-0412.2001.800119-2.pp.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Sir, I have read the letter from Varga and Bódis with interest, accounting for a comparative evaluation of the Misgav Ladach (M/L) cesarean section (CS), lower midline incision (LMI) and Pfannenstiel (PF) CS. They show results from two years, comparing 366 patients in a non-randomized study. Significant differences according to operation time, number of drains and duration of the hospital stay, were found, beneficial to the M/L method. Fewer patients were hospitalized for more than 5 days, and less hospital expenses were related to the M/L operations. Regional anesthesia was most frequently used and antibiotic therapy least frequently used in the M/L group. It is of great importance to discuss this new method of cesarean section, as it is now introduced in many countries and knowledge is gained. Furthermore, modifications of the method are discussed. In my opinion modifications of any surgical procedure should be evaluated in randomized studies to assess if improvements are made or not. The authors have in a commendable way followed the details of Stark’s original description of the method, with one small exception. Concerning the closure of the skin, Varga and Bódis use two Donati stitches, with knots tied caudally, instead of mattress sutures, in combination with small forceps pinching the skin edges together for approximately 10 min. This method has been described earlier and evaluated in our article (1) and communicated with Stark. Holmgren et al. (2) comment Ayres-de-Campos’ and Patricio’s modifications with 5–8 skin stitches (3), that good cosmetic results of 2–3 mattress sutures were found in 800 patients. However, alternative ways of closing the skin may be worth studying separately, while the use of forceps has not easily been accepted. Varga and Bódis raise another question in their letter. They have experience from more than 50 cases of CS after a previous laparotomy or CS. They suggest that M/L CS may be used in a subsequent operation, which is also my experience. In 17 operations following M/L CS they observed two minor omental herniations into the abdominal wall. We have the same experience in Uppsala, that a fixed omentum attached to the abdominal wall can cause difficulties, in repeat procedures. In a retrospective study from Uppsala University Hospital, we surveyed the reports of 50 repeat CS. The surgeon documented difficulties related to the opening of the abdomen, in 25% after a previous LMI, in 59% after one previous PF, in 74% after two earlier PF and in 43% after a M/L CS, respectively. Stark showed 6% intraabdominal adhesions in repeat operations after M/L CS and 29% after Pfannenstiel CS (4). Varga and co-workers are satisfied with M/L CS. The method was used in 92% of the CS the last year. More randomized studies are ongoing and will add to our knowledge of the M/L method. It will be interesting to follow the progression and development of the method. References 1 Darj E & Nordström M-L. The Misgav Ladach method for cesarean section compared to the Pfannenstiel method.Acta Obstet Gynecol Scand1999; 78: 37 – 41. 2 Holmgren G, Sjöholm L & Stark M. Reply from the authors to Ayres-de-Campos and Patricio.Acta Obstet Gynecol Scand2000; 79: 327. 3 Ayres-de-Campos D & Patricio B. Modification to the Misgav Ladach technique for cesarean section.Letter. Acta Obstet Gynecol Scand2000; 79: 326 – 327. 4 Stark Met al. Evaluation of combinations of procedures in cesarean section.Int J Gynaecol Obstet1995; 48: 273 – 276.DOI: 10.1016/0020-7292(94)02306-j Address for correspondence:Elisabeth Darj, M.D., Dr. Med. Sci. Department of Women’s and Children’s HealthSection of Obstetrics and GynecologyUniversity HospitalS-751 85 UppsalaSweden Volume80, Issue1January 2001Pages 91-91 ReferencesRelatedInformation