Comparative Efficacy of Uterine Suturing Techniques on Postoperative Recovery Following Repeat Caesarean Section: A Retrospective Cohort Study in Patients With Scarred Uteri.

AIM: The optimal uterine suturing technique for repeat caesarean section in women with a scarred uterus remains controversial, and evidence comparing novel techniques, such as the breakwater suture, with conventional methods in terms of comprehensive recovery is limited. The objective of this study is to investigate the combined effects of single-layer suturing, double-layer suturing, and breakwater suture techniques on postoperative recovery in patients with scarred uteri undergoing repeat caesarean section.

METHODS

In this retrospective cohort study, 300 pregnant women with scarred uteri undergoing repeat caesarean section at The Maternal and Child Health Care Hospital of Tong Xiang between January 2022 and December 2024 were included. The sample was divided into three groups based on the type of suture used: single-layer suture group (n = 108), double-layer suture group (n = 103), and breakwater suture group (n = 89). Primary outcomes comprised postoperative recovery time, complications, uterine healing status, psychological state, and sleep quality.

RESULTS

There were no significant differences in baseline characteristics among the three groups (p > 0.05). Regarding postoperative recovery, the breakwater suture group demonstrated significantly shorter time to anal flatus, time to first ambulation, and postoperative hospital stay compared with both the single-layer and the double-layer suture groups (p < 0.05). Postoperative ultrasound revealed significantly greater uterine segment myometrial thickness in the breakwater suture group compared to the other two groups (p < 0.001). At six months postoperatively, the incidence of uterine diverticulum in the breakwater suture group (4.5%) was significantly lower than that in the single-layer suture group (15.7%); the overall difference among the three groups was statistically significant (p = 0.041). Furthermore, patients in the breakwater suture group demonstrated significantly better postoperative outcomes on the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Edinburgh Postnatal Depression Scale (EPDS), and Pittsburgh Sleep Quality Index (PSQI) compared with the other groups (p < 0.001).

CONCLUSIONS

In repeat caesarean sections in women with scarred uteri, the breakwater suture technique comprehensively promotes postoperative recovery and may be recommended as a suturing method.