Comparison of surgical techniques used for closure of the uterus in cesarean section on an animal model

Comparison of Surgical Techniques Used for Closure of the Uterus in Cesarean Section on an Animal Model Objective: Although cesarean section is a widely performed operation worldwide, there is limited information about the most appropriate surgical technique. In our study, we aimed to compare the short-term results of the surgical techniques used to close the uterus during cesarean section on an animal model. Materials and Methods: In this study, cesarean section was performed on the 20th day of 10 female Wistar albino rat pregnancies. While the single-layer locked closure technique used for the right side of the uterus, the double-layer unlocked closure used for the left side. Three rats in the control group were followed up during normal delivery. After the rats were sacrificed on the 15th postoperative day, hysterectomy was performed and the material was taken for pathological examination. The sections obtained were stained with hematoxylin-eosin, Masson's trichrome and alcian blue. Macroscopic and microscopic data were analyzed separately for right and left uterus of rats with cesarean section. Results: The mean endometrial thickness of the specimens with a single-layer locked of the uterus was 287±111.1 μm, and the mean endometrial thickness of the specimens closed double-layer unlocked was 318.4±172.2 μm. There is no significant difference was observed between the two groups (p: 0.870). Although the mean myometrial thickness of the single-layer locked closure samples was 637.1±243.1 μm and the mean myometrial thickness of the double-layer unlocked closure samples was 456±261.7 μm, no significant difference was observed between the two groups (p: 0.086). The mean uterine thickness found 1230.9±507.7 μm in single-layer closure and 1466.5±448.9 μm in double-layer closure. No significant difference was observed between the two groups (p: 0.369). There was no significant difference in the rats in the study group in terms of the histopathological features of the hysterectomy materials that we compared. There was an inflamed and necrotic appearance in the uterus of 2 rats whose uterus was closed single layer locked and only one rat in the double layer unlocked closed group (p:0.513). There was no significant difference between the two groups in histopathological evaluations such as collagen, gland density, inflammatory lymphocytes, hemosiderin-loaded macrophages and residual suture (respectively p:0.606, p:0.329, p:0.121, p:1, p:0.513, p:0.264). Discussion: This research contributes to the discussions about the cesarean section technique with a study in which the data are mostly presented with histopathological results. As this thesis study only deals with the early results in uterine healing, no difference was found between the endometrial and myometrial thicknesses between the materials in the control group with no scars, and the cases in group 1, where the uterus was sutured with a single layer locked; and in group 2, where the uterus was sutured double layer unlocked. When all fold measurements of the uterus were made, it was observed that group 1 was thicker than the others. This result is the exact opposite of the view that up to now double suturing will provide a stronger cesarean section. Moreover, the fact that there was no difference between groups 1 and 2 in terms of histopathological features suggests that it would not be appropriate to evaluate only with thickness. It should not be expected that such a complex issue can be solved simply with single or double layer closure. Conclusion: The results of our study indicate that there is no histopathologically distinguishable difference in the short term after cesarean section between closure of the uterus with single layer locked or double layer unlocked. Keywords: Cesarean section, surgical technique, single-layer closure, double-layer closure