Extraperitoneal Cesarean Section Research Articles

Comparison between extraperitoneal and transperitoneal cesarean section: Retrospective case-control study.

The main advantage of extraperitoneal cesarean section (EXPCS) is not only less pain, faster recovery, and less potential for infection but also a possible lack of intraperitoneal adhesions. In a 3-year period from 2019 to 2022, 88 EXPCSs were performed. A comparison was made with 90 patients who underwent a standard transperitoneal cesarean section (TPCS). For both groups, the inclusion criterion was uterine inertia and prolonged labor as an indication for cesarean section. Only pregnant women from 37 to 42 weeks were included. After this, 51 patients remained in the EXPCS arm, and 49 remained in the TPCS arm. No statistical difference was found in gestational weeks, newborn weight, Apgar score, erythrocyte (Er), hemoglobin (Hgb), and hematocrit (Htc) values and duration of operative time between the EXPCS and TPCS groups. Leukocytes, C-reactive protein (CRP) with fever higher than >38°C on the third postoperative day were found statistically significantly (p=0.005) higher in the TPCS group. The usage of tramadol + metamizole at 3, 6, and 9 hours after delivery and diclofenac at 6, 12, and 18 hours after surgery was statistically significantly (p<0.05) higher in the TPCS group. On the visual analog scale (VAS) 24 hours after surgery, a statistically significant difference was found (p = 0.001) between the two groups. In the small group of patients who underwent a TPCS section after an EXPCS, intraperitoneal adhesions were not found; in another group of patients who underwent a TPCS twice, adhesions were found in 12 patients; Fisher's exact test (p=0.04). The protective effect of EXPCS for infection could be proven in prolonged delivery. EXPCS could be a good solution in the fight against adhesions and infection in women who undergo second, third, or even fourth cesarean sections.

The French Ambulatory Cesarean Section: Safety and Recovery Characteristics

ObjectivesThe French AmbUlatory Extraperitoneal Cesarean Section (FAUCS) is aimed at improving patients’ birth experience and recovery. However, data are scarce regarding its maternal and neonatal safety. This study seeks to compare maternal and neonatal outcomes between FAUCS and conventional cesarean deliveries at term. MethodsThis was a retrospective cohort study involving women who underwent scheduled cesarean deliveries at term. We compared a total of 810 cases using the FAUCS technique with 217 cases using conventional cesarean deliveries. Surgical complications, adverse neonatal events, and maternal recovery parameters were compared. ResultsThe incidence of overall surgical complications was comparable between the 2 groups, with rates of 1.97% for FAUCS and 1.85% for the conventional cesarean deliveries. The rates of specific complications such as bladder injury (0.1%), bowel injury (0.1%), blood transfusion (1.35%), and postpartum hemorrhage (1%) were consistent with existing literature. Neonatal outcomes, including neonatal acidemia and admission rates to the neonatal intensive care unit, were comparable between the groups and demonstrated favourable comparisons with previously reported data. Notably, women in the FAUCS group required less analgesia, with only 0.8% receiving morphine, as opposed to 38% in the control group. Furthermore, the FAUCS group demonstrated significantly quicker recovery, with 86% achieving autonomy and early discharge at their discretion within 48 hours after operation, in contrast to only 17% in the control group. ConclusionsWhen performed by experienced practitioners, FAUCS proves to be a safe procedure, with no increased risk for maternal or neonatal complications. Its significant benefits in terms of enhancing maternal recovery are noteworthy.

Minimally Invasive Cesarean Section - Extraperitoneal Cesarean Section. The Outcomes of Applying to the Same Patient More than Once. Case Series.

Extraperitoneal caesarean section (EPCS) provides intraoperative and postoperative advantages to patients compared to transperitoneal (TPCS). Nevertheless, it is less preferred. Extraperitoneal caesarean section (EPCS) is a type of caesarean section performed without entering the peritoneal cavity. In this study, EPCS was successfully performed again in patients who had previously undergone EPCS. This method, which reduces maternal mortality and health expenditures, can be performed more than once.

A novel extraperitoneal cesarean section of supravesical approach: Operative techniques.

We have established a novel extraperitoneal cesarean section technique by supravesical approach. An advantage of this technique over the conventional paravesical approach is that the lower uterine segment is broadly exposed and that all operative procedures can be performed under direct vision. We present the details of this novel technique. The bladder and the peritoneum are exposed by removing the transversalis and extraperitoneal fasciae. Subsequently, a triangular area between the median umbilical ligament, the peritoneum, and the bladder is exposed. The median umbilical ligament is dissected at this site. Bladder dissection from the peritoneum is also initiated from this area and proceeds toward the lower uterine segment. Operative times for pelvic fascia dissection and bladder removal from the peritoneal surface are currently around 15-25 min. During the process of development of this technique, there have been no bladder injuries in 501 patients that caused urine leakage. The supravesical approach has been considered difficult due to the strong adhesion between the perivesical fascia and the peritoneum at the bladder fundus. In this paper, we show how to safely remove the bladder fundus from the peritoneum. The bladder can then be easily lowered down toward the lower uterine segment. Although this technique allows the lower uterine segment to be broadly exposed and all operative procedures can be performed under direct vision, a disadvantage is the comparatively long time currently required to perform it. This technique could be a valuable option for extraperitoneal cesarean section, but disadvantages must also be considered.

Comparison of extra-peritoneal cesarean section with conventional trans-peritoneal cesarean section: An open label randomized controlled trial.

To ascertain whether extra-peritoneal approach is superior to conventional trans-peritoneal approach of cesarean section in terms of fetus delivery time, intra-operative and postoperative outcomes, including return of bowel activity and pain. An open-label randomized controlled trial conducted over one year and six months at a tertiary care center in India. As per sample size calculation, 68 women enrolled in the study; 34 underwent extra-peritoneal, and another 34 underwent trans-peritoneal cesarean section after randomization. Statistical analysis was done with independent sample 't' test, chi-squared test, and fisher's exact test. Baseline characteristics were comparable in both groups. Fetus delivery time was significantly higher in extra-peritoneal than trans-peritoneal cesarean section (14.26±1.26 vs. 9.38±1.83min; p=<0.001). Total operation time was also higher in extra-peritoneal than trans-peritoneal approach (63.24±12.74 vs. 57.41±8.62min; p=0.027). Whereas average blood loss was comparable in both groups (733.82±219.06 vs. 694.12±351.57ml; p=0.063). Postoperatively, return of bowel activity was significantly earlier in extra-peritoneal than trans-peritoneal approach (4.59±0.56 vs. 8.65±1.23h; p=<0.001). Mean time taken for passage of flatus was also significantly less in extra-peritoneal cesarean section (8.56±0.99 vs. 12.76±2.05h; p=<0.001). Pain score at 6, 12, and 18h was significantly lower in extra-peritoneal approach. No patient in extra-peritoneal approach had nausea, vomiting, and abdominal distension. Whereas 11.8 % of patients had nausea, 5.9 % had constipation, and 14.7 % had abdominal distension in trans-peritoneal cesarean section. Requirement of injectable antibiotics and analgesics, and hospital stay was less with extra-peritoneal approach. Extra-peritoneal cesarean section is associated with better postoperative outcomes with respect to return of bowel functions, pain, and requirement of injectable analgesics and antibiotics than the routine trans-peritoneal cesarean section. However, the significantly higher fetus delivery time questions its feasibility in patients with acute fetal distress. Additionally, it is technically difficult and has a longer learning curve.

Extraperitoneal versus transperitoneal cesarean section: a retrospective study

ABSTRACT Objectives To evaluate extraperitoneal cesarean section as a routine elective surgery. Methods In this retrospective study, 461 primiparas were divided into the extraperitoneal and transperitoneal cesarean section groups according to the operation type in a random, but non-blinded, manner. The outcome measures were intraoperative blood loss, operation duration, postoperative gas passage time, postoperative pain, postoperative complications, and neonatal indicators Results The operation duration of the extraperitoneal cesarean section group was significantly lower than that of the transperitoneal cesarean section group (P < 0.05). Compared to the transperitoneal cesarean section group, the extraperitoneal cesarean section group had neonates with higher birth weights and fewer neonatal transfers (P < 0.05). There was no difference in other maternal surgical or neonatal complications between the two groups. Conclusion While extraperitoneal cesarean section can be safely performed as a routine procedure in the surgical delivery of primiparas, it must be performed by well-trained surgeons. In view of its advantages, it is worth being promoted in senior general hospitals as a routine choice. Abbreviations: CS: Cesarean section; ECS: Extraperitoneal; TCS: Transperitoneal; VAS: Visual analogue scale.

Lactococcus lactis cremoris intra-uterine infection: About an uncommon case report.

BackgroundWhen intra-uterine infection (IUI) is suspected or confirmed, intravenous antibiotic therapy providing coverage against common organisms (S. agalactiae and E. coli) is recommended to be administered immediately in order to reduce the risk of maternal and neonatal infectious complications. Nevertheless, it happens that some infections are due to uncommon microorganisms that do not respond to probabilistic treatment. Therefore, samples with bacteriological examination remain systematic. Moreover, the extraperitoneal cesarean section avoids the opening of the peritoneal cavity used in the Pfannenstiel technique and thus reduces the risk of infectious dissemination.Case presentationWe hereby present the uncommon case of a 19-year-old primigravida woman who was referred to our facility for acute gastroenteritis at 34 weeks of gestation. The hospital course was complicated by premature rupture of the membranes followed by the development of fever, chills and deterioration of the fetal heart rate (FHR), imposing an urgent extraperitoneal cesarean section for suspected IUI with fetal impact. Bacteriological examination of a placental sample subsequently yielded growth of Lactococcus lactis cremoris which makes it to our knowledge the second case reported to date of an IUI due to this bacterium.Clinical discussion and conclusionIUI predominantly occurs by ascending bacterial invasion from the lower genital tract to the typically sterile amniotic cavity in the setting of membrane rupture. Extraperitoneal cesarean section serves as a viable alternative to classic transperitoneal delivery in the presence of uterine infection by controlling bacterial spread.Our case serves as a reminder that IUI can arise from multiple pathogens, including Lactococcus lactis cremoris which is known as a harmless bacterium.

Randomized Control Study of Extra Peritoneal Verses Trans Peritoneal Cesarean Section in View of Operative Morbidity

Introduction: Increase incidence of caesarean section is a major concern in todays era. Ceaser may be performed in one of the three way, by classic technique, by lower segment or by some form of extraperitoneal cesarean section. The earliest extraperitoneal technique used was Latzko’s as introduced by Dr Henry Burns. Extraperitoneal cesarean section is a useful method of preventing postoperative morbidity in form of infections &amp; adhesions. Early ambulation , Start oral fluids immediately and get the patient out of bed as soon as the anesthesia worn off are supposed to be advantages of this new study of old technique. Objective: To evaluate advantages or disadvantages of extra peritoneal caesarean section over trans peritoneal caesarean section. Study Design: Single blinded Randomized prospective control triel were performed over 66 patients in our tertiary care institute. Intra operative complications morbidity and outcome compaired by scaling signs, symptoms &amp; examination findings by single consultant. Results: Patients of ECS had better score for postoperative pain, ambulation &amp; oral intake there were less requirement of analgesic in ECS group. Postoperative nausea, shoulder pain febril episodes peritonitis genitourinary tract infection &amp; bowel discomfort were very minimal in ECS group compaire to TCS group. Conclusion: An extra peritoneal csection is definitely advantageous over transperitoneal approach of lower segment caesarean section. There is no need for postoperative starvation, and ileus after this method is rare. Early mobilization reduces the risk of thrombosis and shortens postoperative pain. Less pain makes early commencement of breastfeeding easier within the first hours after the operation. This will also help contraction and involution of the uterus. Early removal of stitches reduces the risk of infection and keloids.

Reply to the Letter to the Editor: Extraperitoneal cesarean section and transperitoneal cesarean section: does extraperitoneal technique shorten the duration of surgical operation?

No abstract available

Letter to the Editor: Extraperitoneal cesarean section and transperitoneal cesarean section: does extraperitoneal technique shorten the duration of surgical operation?

No abstract availabe

In New Geon Extra Peritioneal Caesarean Section An Observational Study

This study was designed to find out the maternal and perinatal outcome among 80 women undergoing extraperitoneal cesarean section. This observational study was conducted at Institute of Child and Mother Health, Matuail, Dhaka from 1st March 2013 to 28th February 2014. Data were collected by structured questionaire ith the writen consent of patients irrespective of routine and emergency cases where the procedure was successful in all patients. During operation, time was taken from open to close, incision to delivery of baby, total amount of blood loss during procedure, intraoperative complications, APGAR score of newborn were documented. Time required for return of bowel sound mobilization of patient within 24 hour and, duration of hospital stay were also included. Success rate of extra peritoneal CS was 100%, Time taken from incision to delivery was ≤6 minutes in 62.2% cases, time taken from incision to closure was between 31-45 min in 72.5% cases, blood loss ≤500 ml in 62% cases, return of bowel function between 5-8 hours in 52.5%, mobilization within 24 hours in 52.5%, neonatal one minute APGAR score ≥7 in 93.91%. As a surgical form of infection prophylaxis extraperitoneal cesarean section can be applied to avoid serious post-operative pelvic infections and its complications Extraperitoneal cesarean section would be a rational practice of cesarean section in the modern era.&#x0D; Bangladesh Med J. 2017 Sep; 46 (3): 94-96

Comparison of extra-peritoneal and intra-peritoneal cesarean technique: a prospective randomised trial

Objective: Comparison of extra-peritoneal cesarean (EPC) and intra-peritoneal cesarean (IPC) section in terms of postoperative pain, pulmonary function, fever, gastrointestinal function, and other maternal and fetal morbidities. Materials and Methods: Fifty patients were included in this prospective study. All patients' demographic data such as blood count, gestational week, height, weight, body mass index, and age were recorded in the preoperative period. Forced vital capacity, forced expiratory volume at second 1, and peak expiratory flow values were measured before and 24 hours after the operation. Pain was evaluated using visual analog scale (VAS). Time from the beginning of the operation to the delivery, total operation time, birth weight, and Apgar scores were also recorded. Changes in pulmonary function tests, VAS, time to hear bowel sounds, gas and stool discharge times, leukocyte increase rate, fever, and C-reactive protein values were compared between the groups. Results: Lower abdominal and incision pain were less in the EPC group (p p Conclusion: EPC section seems to be advantageous in terms of postoperative pain, pulmonary function, intestinal function, and febrile morbidity. Further studies with larger populations are needed in order to recommend this technique routinely.

Fetus delivery time in extraperitoneal versus transperitoneal cesarean section: a randomized trial

Objective: We compared the extraperitoneal cesarean section to transperitoneal cesarean on fetal delivery time.Material and methods: This randomized study included 210 pregnant women undergoing cesarean section for elective reasons, repeat cesarean (< four), or dystocia. Patients who required an urgent cesarean section, who were at high risk for obstetric or maternal bleeding, who had a uterine or adnexal mass, or who requested tubal ligation were excluded from the study. The primary outcome of the study was the skin incision-to-delivery time. The sample size was set to detect of 1-minute difference in fetal delivery time between groups (two-tailed hypothesis, α = 0.05, β = 0.10). Secondary outcome measures were total operation time, intraoperative nausea, gag reflex, vomiting, pain and anxiety for those receiving regional anesthesia, postoperative pain, change in hemoglobin, postoperative analgesic requirements, nausea, vomiting and shoulder pain, urogenital distress, time until gas passage, and neonatal outcome.Results: No significant difference occurred between the two groups for skin incision-to- delivery time (extraperitoneal cesarean 3.9 minutes [2.1–7.3] versus transperitoneal cesarean 4.2 minutes [1.9–8.2], p = .065). Significant differences regarding intraoperative pain, total operation time, postoperative pain at the surgical site and shoulder pain, analgesic requirements, time until gas passage, and oral tolerability favored the extraperitoneal group. No significant differences between groups occurred regarding other seconder outcome parameters.Conclusions: There is no clinically significant difference between extraperitoneal cesarean section and transperitoneal cesarean on fetal delivery time. Extraperitoneal cesarean reduces postoperative pain, analgesic requirements, and improves oral tolerability.

Clinical analysis of extraperitoneal cesarean section plus forceps in repeated cesarean section

Objective To observe the clinical application of extraperitoneal cesarean section(ECS) plus forceps vs transperitoneal cesarean sections(TCS) in repeated cesarean section. Methods 98 multiparous women with scar uterus for elective repeated cesarean sections were recruited retrospectively,47 cases for ECS plus forceps(group A),and 51 cases for TCS(group B).The multiparous women with hyperglycemia not controlled,severe preeclampsia,heart disease,placenta previa,premature rupture of membrane,a history of> 1 cesarean section,myoma and/or ovarian neoplasm were excluded. Results Skin incision to baby delivery time and total operation time of group A were(7.7±2.8)min and(42.8±9.7)min,respectively,which were significantly shorter than(9.3±3.2)min and(47.6±9.4)min of group B,(t= 2.700,2.497,P= 0.008,0.014).There was significant difference in blood loss volume during the operation and postoperative 2 hours,which was(310.4± 106.3)m L,(365.3±142.8)m L respectively(t= 2.142,P= 0.035).The Visual Analog Scale for pain(VAS pain) was(2.8±1.8)in group A and(4.1±1.9)in group B,respectively(t= 3.252,P= 0.002).The gastrointestinal function recovery mean time of group A was significantly shorter than that of group B(12.5h versus 16. 0h,t= 2.771,P= 0.007).And the postoperative febrile morbidity was significantly lower in group A than in group B(8.5% versus 25.5%;χ2= 4.918,P= 0.033).The patients with chronic pelvic pain followed up after operation was 3 versus 12,and the difference was significant(χ2= 5.143,P= 0.026).There were no differences in neonatal Apgar score at 1 minute,birth asphyxia and wound healing rates. Conclusion ECS plus forceps can be safely used for repeated cesarean section,with the advantages of less operation time,less bleeding volume, lower postoperative morbidity,and fewer complications than TCS. Key words: Cesarean section; Obstetrical forceps; Cesarean section,repeat

Extraperitoneal Versus Transperitoneal Cesarean Section

Objective We sought to test the hypothesis that an extraperitoneal cesarean section (ECS) technique reduces postoperative pain without increasing intraoperative and postoperative complications. Study Design In a single-center, single-blinded prospective trial we randomized 54 patients with an indication for primary or first repeat cesarean section at term pregnancy to an ECS (n = 27) or transperitoneal cesarean section (TCS) (n = 27) procedure. Patients with suspected abnormal placentation, a history of >1 cesarean section, or major abdominal surgery were excluded. The primary endpoint of the study was maximum abdominal pain measured by numeric rating scale ranging from 0–10. Results Patients after ECS had significantly less maximum surgical site pain than patients after TCS. Median peak pain scores on postoperative day 1 were 4.00 (interquartile range, 3.00–5.00) for ECS and 5.00 (interquartile range, 4.00–7.00) for TCS, respectively ( P = .031). Analgesic requirements, intraoperative nausea, and postoperative shoulder pain were significantly less after ECS. Overall operative time was significantly shorter in ECS, with no difference in delivery time. No bladder injury occurred in either group. There were no differences in estimated blood loss and neonatal outcome. Urogenital distress, urinary tract infection, and bowel dysfunction did not differ at discharge from hospital and 6 weeks after. Conclusion An extraperitoneal approach to cesarean section appears to reduce postoperative pain, usage of analgesics, and intraoperative nausea without an increase in significant complications.

Conception by IVF-ET after four previous laparotomies, but requiring extraperitoneal cesarean section at 33 weeks due to hypertension and deteriorated renal function

Conception by IVF-ET after four previous laparotomies, but requiring extraperitoneal cesarean section at 33 weeks due to hypertension and deteriorated renal function

Extraperitoneal versus transperitoneal cesarean section: a prospective randomized comparison of surgical morbidity

We sought to test the hypothesis that an extraperitoneal cesarean section (ECS) technique reduces postoperative pain without increasing intraoperative and postoperative complications. In a single-center, single-blinded prospective trial we randomized 54 patients with an indication for primary or first repeat cesarean section at term pregnancy to an ECS (n= 27) or transperitoneal cesarean section (TCS) (n= 27) procedure. Patients with suspected abnormal placentation, a history of >1 cesarean section, or major abdominal surgery were excluded. The primary endpoint of the study was maximum abdominal pain measured by numeric rating scale ranging from 0-10. Patients after ECS had significantly less maximum surgical site pain than patients after TCS. Median peak pain scores on postoperative day 1 were 4.00 (interquartile range, 3.00-5.00) for ECS and 5.00 (interquartile range, 4.00-7.00) for TCS, respectively (P= .031). Analgesic requirements, intraoperative nausea, and postoperative shoulder pain were significantly less after ECS.Overall operative time was significantly shorter in ECS, withno difference in delivery time. No bladder injury occurred in either group. There were no differences in estimated blood loss and neonatal outcome. Urogenital distress, urinary tract infection, and bowel dysfunction did not differ at discharge from hospital and 6weeks after. An extraperitoneal approach to cesarean section appears to reduce postoperative pain, usage of analgesics, and intraoperative nausea without an increase in significant complications.

The clinical analysis of 128 cases of extraperitoneal cesarean section

Objective To explore the advantages of extraperitoneal cesarean section.Methods 128 cases of extrperitoneal cesarean section (extraperitoneal group)and 128 cases of conventioneal intraperitoneal cesarean section (intraperitoneal group)were compared.Results The preoperative blood,the time from a skin incision to the baby delivered,the total operative time and neonatal Apgar scores of two groups were compared,there was no significant difference(P＞0.05).While the exhaust time after the operation,ambulation time,postoperative antibiotic time,postoperative hospital,illness and complications after operation had significant difference(P＜0.05).Conclusions There is no abdominal operations,no bowel adhesion and bowel abstruction,little complications,faster recovery of gastrointestinal function,and the operation method is simple to master,such as recovery of gastrointestinal function.It's suitable for clinical application. Key words: Extraperitoneal cesarean section; Intraperitoneal cesarean section; Bowel adhesion

Cervical Abscess with Vaginal Fistula After Extraperitoneal Cesarean Section

Extraperitoneal cesarean section was once used for the prevention of infection and postoperative adhesion. However, we report an unusual complication after this procedure. A 29-year-old woman had pus discharge from the anterior vaginal wall after extraperitoneal cesarean section. Broad-spectrum antibiotics failed to relieve her symptoms and vaginal culture yielded Morganella morganii . Magnetic resonance imaging, sagittal view, showed a cervical abscess measuring 5 x 5 cm with a tract extending to the anterior vagina. After performing dilation and abscess drainage via the cervical ostium, the symptoms gradually subsided with adequate antibiotic treatment. Cervical abscess may develop after extraperitoneal cesarean section and present initially as vaginal fistula. Detailed imaging study provides comprehensive anatomic information for effective management.

Preparing for obstetrics in the twenty-first century: Quo vadis?: Presidential address

Quo vadis: Whither goest thou? Before we attempt to predict, anticipate, and project the status of the complexities of obstetrics in the 1990s as we approach the twenty-first century, perhaps we should first look to our past and examine what has been accomplished by our obstetric predecessors. Our Society held the first organizational meeting November 19 and 20, 1931, at Stanford Hospital. C. Frederic Fluhmann' believed vitamin E had a therapeutic value. Raymond E. Watkins presented an article on unexpected fetal death as one of the fundamental problems of obstetrics and contended that its prevention would materially reduce fetal mortality. At this meeting Frank W. Lynch' summarized the first organizational meeting by stating, I cannot help wondering how our discussions will sound twenty years later. By that time many conditions not understood will have adequate explanation. During the 1930s and 1940s the obstetric papers presented at the annual meeting concerned such subjects as toxemia, x-ray pelvimetry, maternal and infant mortality, premature rupture of membranes, diabetes, breech deliveries, external version, the legal aspects of obstetrics, and extraperitoneal cesarean section. Constant fetal monitoring done the old-fashioned way by auscultation of the fetal heart to assist in evaluating the condition of the fetus was stressed. Henry N. Shaw' discussed the use of the peritoneoscope in the diagnosis of ectopic pregnancies. In 1935 Sterling Pierce' presented the problem of the golden yellow baby. Phenobarbital sodium and scopolamine were routinely used to produce analgesia. This subject produced considerable controversy concerning sedation and resuscitation