Comparison between the use of the Joel-Cohen incision and its modification during Stark's cesarean section

Objective: a comparative outcome evaluation between the Joel-Cohen incision and its modified version during Stark's Cesarean Section (CS). Material & Methods: in a retrospective study ;477 women who underwent Stark-CS were evaluated: 204 with the Joel-Cohen incision (JC), and 273 with a modified Joel-Cohen incision (MJC). The reference parameter for the evaluation criteria of the study have been: febrile morbidity, need for pain killers, duration of hospital stay and ultrasound examination for blood collections (BC) in the third postoperative day. The blood collections, when diagnosed were divided into 3 main groups depending on the site: collections in the abdominal wall (a), in the pouch of Douglas (b) and in the lower uterine segment (LUS) (c). The including criteria for the two groups were term low-risk primiparae who were submitted to CS for breech presentation, macrosomia and on demand. All patients were operated under combined Spinal-Epidural anesthesia; statistical evaluation was performed by SAS/V12 software. Results: There were no statistical differences between the two groups concerning febrile morbidity, duration of need for pain killers and hospital stay. Statistically more blood collections were found in the classical Joel-Cohen incision (1.4% in group a, 7.6% in group b and 6.5% in group c) compared to the modified Joel-Cohen Incision (7.3% in group a, 15.6% in group b and 11.2% in group c), however without any clinical significance. Conclusions: The routine use of the classical Joel-Cohen incision during the Stark's CS seems to be more rational, and is causing less blood collections.