Transverse uterine incision non-closure versus closure: an experimental study in sheep

Subject. This study was designed to investigate whether the non-closure of the layers of the uterus during low transverse cesarean section would resul t in healing and have advantage on closure. Material and method. Thirty pregnant ewes randomly divided into two groups. Each group included 15 ewes. Each ewe was anesthetized at para-vertebral r egion with the injection of 20 ml Prilocine 2%. Following left transverse a bdominal incision, a transverse incision was made on the uterus and lambs w ere delivered. In the first group, uterine incision line was left open. In the second group, uterine incision line was sutured with no. 1 Chromic catg ut by Schimiden technique. In both groups, all layers of abdominal wall exc ept skin were sutured as en-bloc with Vicryl(R) no. 2, by continuous suture technique. Skin was sutured with no. 00 silk interrupted sutures. The ewes were slaughtered four months after cesarean section. A coworker was asked to open the abdominal cavities, and score the intra-abdominal adhesions. Ti ssues taken from incision line of each uterus were fixed in 10% neutral buf fered-formalin and were embedded in paraffin-block. Sections were cut and s tained with hematoxylin-eosin. A pathologist, who knew nothing about the st udy, evaluated all sections, and reported the findings. Strident's t test w as used for comparison of mean ewe age, gestational age, and mean operation time of the two groups. Z test was used for comparing the ratio of the two groups by means of histopathological findings. Results. No cervical dilatation and delivery of the placenta were seen duri ng the four week follow up period. The average operating time was significa ntly less for the non-closure group (48.07+/-3.83 minutes) than for the clo sure group (62.53+/-6.57 minutes; p=0.001). The ranges of myometrial necros is (100% versus 13.3%; p=0.001) and endometriosis (53.3% versus 00.0%: p=0. 001) were significantly higher for closure group than for non-closure group . Conclusion. It was found that non-closure layers of the uterus along low tr ansverse cesarean incision proves to have no adverse effect on immediate an d late postoperative period in ewes. Our data showed that non-closure of al l layers of the uterus results in significantly less muscular necrosis and endometriosis than closure group. We suggest that lower uterine incision ca n be left unclosed or, at least, simple closure can be preferable instead o f vigorous locking technique.