Knot Burial Technique for Rectus Sheath Closure

Overview

Caesarean section is one of the most commonly performed abdominal operations on women in most countries of the world. Its rate has increased markedly in recent years, and is about 20-25% of all child-births in most developed countries.

The present study was a step to reduce postoperative pain in cesarean sections. Because of the large number of women that undergo caesarean section, even small differences in post-operative morbidity rates due to different techniques could translate into improved health and significant savings of cost and health services resources.

Closing the rectus sheath in cesarean sections with the knots pricking through the skin causes significant postoperative pain, discomfort and delayed ambulation. No comments in literature regarding the best way for closing the rectus sheath in cesarean sections.

AIM/ OBJECTIVES The aim of this study is to assess the efficacy of burying knots beneath the rectus sheath during cesarean section in reducing post operative pain and discomfort.

Study hypothesis:

In women undergoing cesarean sections may or may not burying knots beneath the rectus sheath reduce the post operative pain and discomfort.

Full Title of Study: “Knot Burial Technique for Rectus Sheath Closure in Relation to Post Operative Pain in Elective Cesarean Section”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Health Services Research
    • Masking: Double (Participant, Outcomes Assessor)
  • Study Primary Completion Date: October 9, 2019

Detailed Description

Non absorbable and delayed absorbable monofilament materials require meticulous care to prevent knot slippage.

One common problem that arises from use of these materials is the discomfort caused by the knot pricking through the skin. Although this is a common problem after cesarean section, it is often overlooked and only very few preventive techniques have been described.

This study is to assess the efficacy of burying knots beneath the rectus sheath during cesarean sections in reducing post operative pain and discomfort.

Type of Study : A randomized controlled clinical trial. Study Setting :this study will be conducted at the department of Obstetrics and Gynecology at Ain-Shams University Maternity hospital.

Study time: 2019. Study Population : The study population comprises pregnant women, fulfilling the inclusion criteria, attending to Ain Shams University Maternity Hospital, during the study period, who are planned for cesarean delivery.

Interventions

  • Procedure: knot burial technique
    • surgical suturing intervention
  • Procedure: classical closure
    • surgical suturing intervention

Arms, Groups and Cohorts

  • Active Comparator: classical closure.
    • In this group, the rectus sheath closure will be done by simple running continuous sutures with the knots beneath the subcutaneous layer.
  • Active Comparator: knot burial technique
    • The surgeon holds the left angle of the rectus sheath incision with an Allis. Using (Polyglactin 910) suture,The needle is taken from the inside outward on the upper edge.The needle is then taken lateral to the Allis and brought back into the wound by taking it through the inferior edge from outside to inside . A square knot is tied with three or four throws. The needle is then taken out of the wound through the upper edge and continuous running stitches . As the right angle is approached, the angle is held with an Allis. the suture, will be taken through the lower edge, is brought outside the wound and passed between the blades of a closed Allis before taking it inside out on the upper edge. One more bite is taken but this time just lateral to the Allis holding the angle, and the needle is brought back into the wound and to the outside between the edges of the rectus sheath. Using the loop of polyglactin held with the Allis , an Aberdeen knot is tied after removing the Allis.

Clinical Trial Outcome Measures

Primary Measures

  • changing the post operative pain and discomfort
    • Time Frame: the first twenty-four hours after delivery.
    • by Visual Analogue pain Scale (0) means no pain ,( 10) means sever pain.
  • changing the post operative pain and discomfort
    • Time Frame: one week after delivery
    • by Visual Analogue pain Scale (0) means no pain ,( 10) means sever pain.
  • changing the post operative pain and discomfort
    • Time Frame: two weeks after delivery.
    • by Visual Analogue pain Scale from ,(0) which means no pain to ( 10) means sever pain.

Secondary Measures

  • wound assessment for suture granuloma formation
    • Time Frame: one week post operative
    • by scar tissue palpation for ( presence ) or (absence) of a forming mass.
  • early ambulation after cesarean section
    • Time Frame: two hours after delivery
    • by observation and history taking , early ambulation within two hours post operative (yes) or (no)
  • early breast feeding after cesarean section
    • Time Frame: two hours after delivery
    • by observation and history taking, early breast feeding within two hours post operative (yes) or (no)

Participating in This Clinical Trial

Inclusion Criteria

  • Term pregnancy ( more than 37 weeks of gestation ) candidate for transverse incision elective cesarean delivery

Exclusion Criteria

  • patient with BMI >30 and fat thickness >3 cm.
  • patient with haemoglobin less than 10g/dL
  • patient with previous history of septic wound.
  • Emergency lower segment cesarean section.
  • Patients complaining of premature rupture of membrane.
  • Patients need intra abdominal drains post cesarean sections
  • Patients with established or gestational diabetes, coagulation defects, hemodynamic instability, septicemia or chorioamnionitis.

Gender Eligibility: Female

Minimum Age: 20 Years

Maximum Age: 40 Years

Are Healthy Volunteers Accepted: Accepts Healthy Volunteers

Investigator Details

  • Lead Sponsor
    • Ain Shams University
  • Provider of Information About this Clinical Study
    • Principal Investigator: Aliaa Ibrahim Gaber Elsayed, Principal investigator – Ain Shams University
  • Overall Official(s)
    • Nashwa elsaid, prof.Dr, Study Director, AinShams University
    • Reda Mokhtar, Lecture, Study Director, AinShams University

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