Evidence-based Cesarean Section for Universal Use | Michael Stark
Summary :
As most abdominal operations have endoscopic alternatives, caesarean section will remain the only future abdominal operation. It is therefore of utmost importance to evaluate the different steps for their necessity and for their optimal way of performance in order to achieve an internationally unified evidence-based method. The modified Joel-Cohen method results in a shorter incision to delivery time and lower rate of febrile morbidity compared to the traditional Pfannenstiel or longitudinal incisions. Opening peritoneum using bi-digital repeated proved to be safe. The uterus is opened in the lower segment where less muscle tissue and more fibrous tissue is present and therefore stronger scars are the outcome. Suturing the uterus with one layer results in a strong scar. The bigger the diameter of the used needle when suturing the uterus, fewer steps are necessary, therefore less suture material is used with less foreign body reaction. Leaving both peritoneum layers unsutured proved to reduce adhesions and result in less need for analgesics. The fascia is sutured continuously with the first knot underneath the fascia. This prevents sub-cutis irritations. This standardized cesarean section method has been evaluated by dozens of peer-reviewed studies. Without any exception, all showed various advantages of this operation: Shorter skin incision to delivery which is important in emergency situations, shorter operation time, less hospital days, quicker mobilization, less blood loss, lower rate of febrile morbidity, lower costs, and less need for analgesics. The risk of overuse of the cesarean section and possible influences on human evolution will be addressed.
About Author :
Prof. Dr. Michael Stark is specialized in Obstetrics and Gynecology. He modified operations like the vaginal and abdominal hysterectomy and Cesarean Section and developed the concept of single-entry natural orifice surgery. He is the President of the New European Surgical Academy (NESA) and a guest scientist at the Charite University in Berlin. In 2011 he was nominated Doctor of the Year in Italy, and is an Honorary Member of the French, Polish, Russian Serbian-Austrian and Italian Gynecological Associations as well as the vice president of the board of specialty committee of Perinatology of World Federation of Chinese Medicine Societies. He was visiting Professor at the Universities of Toronto, Moscow, Milan, Adana, Uppsala and the Weill-Cornell University hospital in New York.
