A novel single-suture cesarean uterine closure technique to prevent bleeding, resuturing and isthmocele: A three-year follow-up retrospective matched cohort study.

OBJECTIVE

The aim of this study was to (i) describe a new single layer continuous unlocked uterine incision closure technique during cesarean delivery (Yilmaz technique) and (ii) compare it with the commonly used single layer continuous locked suture technique regarding isthmocele prevalence and related complications.

METHODS

This retrospective blinded matched cohort study with a three-year follow-up included 60 women who had undergone cesarean delivery. Participants were matched based on the time since cesarean delivery and divided into two groups: the Yilmaz technique group (n = 30) and the control group (n = 30).

RESULTS

Age and body mass index (BMI) were similar between two groups. Ratio of spotting (13.33% vs. 40%) and median post-menstrual bleeding days (0.0 [0.0, 0.0] vs. 0.0 [0.0, 2.0]) were significantly lower in the study versus control group (P = 0.020 and P = 0.019, respectively). Prevalence of the isthmocele was 26.7% and 43.3% in the study and control groups, respectively (P = 0.176). Moreover, after adjustment for the number of previous cesarean sections, the Yilmaz technique remained associated with lower odds of isthmocele (adjusted odds ratio [aOR] 0.26, 95% confidence interval [CI]: 0.06-0.89; P = 0.042) and spotting (aOR 0.06, 95% CI: 0.01-0.32; P = 0.004) and number of postmenstrual bleeding days (ratio of expected counts 0.09, 95% CI: 0.02-0.37; P < 0.001).

CONCLUSION

The Yilmaz technique is a new single layer unlocked horizontal running suture method not only for closure of uterine incision during cesarean delivery but also for management of uterine bleeding and thin uterus at the incision site using single suture material. Moreover, prevalence of isthmocele, spotting and postmenstrual bleeding days were found to be statistically significantly lower in this new Yilmaz technique.