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Nonfreeing of the Lower Leaf of the Rectus Sheath at Caesarean Section: A Randomized Controlled Trial
Author(s) -
Oguz Serdar,
Sener Bilge,
Özcan Sarp,
Akyol Didern,
Gökmen Oya
Publication year - 1998
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1998.tb03075.x
Subject(s) - rectus sheath , caesarean section , pubic symphysis , medicine , surgery , abdominal wall , abdominal cavity , anatomy , general surgery , pelvis , pregnancy , biology , genetics
EDITORIAL COMMENT: This vignette draws attention to a detail of surgical technique familiar to all surgeons who perform the Pfannenstiel incision. Freeing the insertion of the pyramidalis muscles from the rectus sheath is often untidy and can cause considerable haemorrhage. Our literature search confirms the opinion of the reviewers of this paper that nonfreeing of the lower leaf of the rectus sheath at Caesarean section is a new idea and so this brief ‘randomized controlled trial’ was accepted for publication. One reviewer wondered if the trauma to the pyramidalis muscles often encountered at Caesarean section is due to variation in the level (i.e. distance above pubic symphysis) of the transverse skin incision, or variation in the anatomy of the pyramidalis muscles. Readers will accept the shorter time interval to reach the abdominal cavity with the technique described but may wonder if the time from entry of the abdomen to exit of the fetus from the uterus was affected, especially in cases of repeat Caesarean section where scar tissue might affect the ease of manipulation. One reviewer of this manuscript stated that the concept of not separating the rectus sheath from the underlying muscles is not entirely new since S. Joel Cohen advocated the technique in 1972 (Joel Cohen, S. A technique of abdominal and vaginal hysterectomy based on time and motion studies. Heinemann, London 1972, p10).