Evaluation of the incidence and depth of isthmocele with transvaginal ultrasonography after closure of the cesarean section uterotomy incision with "baseball" or single-layer continuous locking suturing techniques: A randomized controlled trial

Cesarean is the most commonly performed major abdominal surgery in the world. Impaired healing of the uterus after cesarean is a complication with obstetric and gynecological consequences. Evidence suggests that the number of previous cesarean and closure method of uterotomy are related with the risk of developing a uterine scar defect. Even though it is the most applied surgical intervention, there is no consensus on surgical techniques, thus randomized studies are needed. We aimed to evaluate the effects of two different uterotomy closure techniques on the presence of isthmocele and residual myometrial thickness after cesarean. The study was designed as a triple blind randomized parallel group trial. Pregnant women that over 37 weeks, had no pregnancy complications and going to undergo uterine surgery for the first time were included in the study. Baseball suturing technique (n=40) and single-layer locked continuous suturing technique (n=40) were used during the uterotomy repair of 80 pregnant women who were admitted to the TOGÜ Obstetrics and Gynecology Clinic for cesarean delivery. The presence of isthmocele and the residual myometrial thickness of the uterine scar tissue at 12 weeks after cesarean section were evaluated by transvaginal sonography. In addition, techniques were compared in terms of additional hemostatic suture requirement, operation times, hemoglobin change and uterine measurements. The baseball suturing technique was associated with reduced presence of isthmocele, less need for additional hemostatic sutures, and greater residual myometrial thickness. It was seen that the Baseball suture technique can be applied for uterotomy repair during cesarean section and is superior to the routinely used single layer locked continuous technique in terms of short-term complications. The findings need further evaluations of long-term complications and to be supported by larger scale studies. Keywords: cesarean section, isthmocele, baseball