SEZARYEN SIRASINDA UTERUSUN TEK YA DA ÇİFT KAT KAPATILMASININ ERKEN HİSTOPATOLOJİK KARŞILAŞTIRILMASI: RATLARDA KONTROLLÜ ÇALIŞMA

Year 2023, Volume: 86 Issue: 3, 220 - 226, 26.10.2023

Merve Civelek , Selim Büyükkurt , Mehmet Bertan Yılmaz , Kıvılcım Erdoğan , Hale Öksüz , Çağrı Avcı , Gülşah Seydaoğlu

https://doi.org/10.26650/IUITFD.1261550

Abstract

Amaç: Sezaryenin birçok uzun dönem komplikasyonu vardır. Yüksek sezaryen oranları nedeniyle bunlar artmaktadır. Uzun dönem komplikasyonların farklı sütür teknikleri ile ilişkisi olduğu düşünülmektedir. Tek kat kilitlenerek (SLL) ve çift kat kilitlenmeden (DLU) en çok karşılaştırılan yöntemlerdir. Bu çalışmanın amacı iki farklı sütür tekniğinin erken dönem histopatolojik sonuçlarını bir deneysel hayvan modelinde karşılaştırmaktır.
Gereç ve Yöntem: On Wistar-Albino rata miadında sezaryen yapıldı. Sağ uterus SLL, sol uterus DLU olarak kapatıldı. Kontrol grubunda ise normal doğum yapmış üç ratın altı uterusu bulunmaktaydı. Doğumdan 15 gün sonra tüm hayvanlara histerektomi yapıldı ve her bir uterus deney ünitesi olarak kullanıldı. Çalışma ve kontrol grupları arasında endometrium ve myometrium ortalama kalınlıkları ile histopatolojik özellikler karşılaştırıldı.
Bulgular: SLL ve DLU gruplarında endometrium (276,6±123,1 vs. 258,4±125,9 μm; p=0,748) ve myometrium (531,7±189,2 vs. 505,9±182,1 μm; p=0,612) skarlı alanda benzer kalınlığa sahipti. Skarsız alanda SLL, DLU ve kontrol gruplarında endometrium kalınlığı sırasıyla 239,9±68,9; 256,5±127,2, ve 316,4±98,6 μm olarak ölçüldü ve benzer olarak değerlendirildi (p=0,347). Benzer şekilde skar olmayan alanda SLL, DLU ve kontrol gruplarında myometrium kalınlığı da benzerdi (387,2±119,9; 364,5±154,1 ve 234,0±49,1 μm; p=0,265). İki farklı teknikle kapatılan uterus örneklerinin histopatolojik özellikleri de benzerdi.
Sonuç: SLL ve DLU teknikleri ile uterus kapatıldıktan sonra uterusların erken dönem histopatolojik özellikleri benzer olarak değerlendirildi. Bu sonuçlara göre uterus nasıl kapatılırsa kapatılsın erken dönemde iyileşme sürecinin etkilenmediğine işaret etmektedir.

Keywords

Cerrahi teknik, uterusun kapatılması, sezaryen, gebelik, histopatoloji

Project Number

TTU-2021-13624

EARLY HISTOPATHOLOGICAL COMPARISON OF SINGLE VERSUS DOUBLE-LAYER CLOSURE OF UTERINE INCISION DURING CESAREAN: A CONTROLLED STUDY IN RATS

Abstract

Objective: Long-term complications of cesarean delivery are numerous and are increasing due to the high cesarean rate. The long-term complications are attributed to the different suturing methods. The single-layer locked (SLL) and double-layerunlocked (DLU) are the most compared. This study aims to compare the early histopathological properties of these two suture techniques in an experimental animal study.
Material and Method: Ten pregnant Wistar-Albino rats had cesarean at term. The right uterine horns were repaired using the SLL suture technique, and the left ones were repaired using the DLU technique. The control subjects were the six uterine horns of three pregnant rats delivered vaginally. Each animal underwent a hysterectomy on day 15 of pregnancy, and each uterus was an experimental unit. The mean thickness of the endometrium and myometrium of the intervention groups with histopathological features and controls were compared.
Result: In SLL and DLU groups, the endometrium (276.6±123.1vs. 258.4±125.9 μm; p=0.748) and myometrium (531.7±189.2 vs. 505.9±182.1 μm; p=0.612) in scarred areas were similar. In nonscarred areas, the endometrium was measured as 239.9±68.9, 256.5±127.2, and 316.4±98.6 μm in SLL, DLU, and control group, respectively (p=0.347). The myometrium of non-scarred areas was also similar in all groups evaluated (387.2±119.9; 364.5±154.1 and 234.0±49.1 μm; p=0.265). The histopathological features of uteri repaired with two different techniques were also similar.
Conclusion: The early histopathological properties of all uteri examined were similar after repairing with SLL or DLU techniques. These results indicate that the repair process does not differ in the early stages, regardless of the uterine closure technique used.

Keywords

Surgical technique, uterine closure, cesarean section, pregnancy, histopathology

Supporting Institution

Scientific Research Fund of the University of Cukurova

Project Number

TTU-2021-13624

References

• 1. Eyi EGY, Mollamahmutoglu L. An analysis of the high cesarean section rates in Turkey by Robson classification. J Matern Fetal Neonatal Med 2021;34(16):2682-92. [CrossRef] google scholar
• 2. ACOG Practice Bulletin No. 205: Vaginal birth after cesarean delivery. Obstet Gynecol 2019;133(2):e110-27. [CrossRef] google scholar
• 3. Abalos E, Addo V, Brocklehurst P, El Sheikh M, Farrell B, Gray S, et al. Caesarean section surgical techniques (CORONIS): A fractional, factorial, unmasked, randomised controlled trial. Lancet 2013;382(9888):234-48. [CrossRef] google scholar
• 4. The CAESAR study collaborative group. Caesarean section surgical techniques: A randomised factorial trial (CAESAR). BJOG 2010;117(11):1366-76. [CrossRef] google scholar
• 5. Dodd JM, Anderson ER, Gates S, Grivell RM. Surgical techniques for uterine incision and uterine closure at the time of caesarean section. Cochrane Database Syst Rev 2014;22(7):CD004732. [CrossRef] google scholar
• 6. Roberge S, Chaillet N, Boutin A, Moore L, Jastrow N, Brassard N, et al. Single- versus double-layer closure of the hysterotomy incision during cesarean delivery and risk of uterine rupture. Int J Gynaecol Obstet 2011;115(1):5-10. [CrossRef] google scholar
• 7. Roberge S, Demers S, Berghella V, Chaillet N, Moore L, Bujold E. Impact of single- vs. double-layer closure on adverse outcomes and uterine scar defect: A systematic review and metaanalysis. Am J Obstet Gynecol 2014;211(5):453-460. [CrossRef] google scholar
• 8. Bij de Vaate AJM, van der Voet LF, Naji O, Witmer M, Veersema S, Brölmann HAM, et al. Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following cesarean section: Systematic review. Ultrasound Obstet Gynecol 2014;43(4):372-82. [CrossRef] google scholar
• 9. Di Spiezio Sardo A, Saccone G, McCurdy R, Bujold E, Bifulco G, Berghella V. Risk of Cesarean scar defect following single- vs double-layer uterine closure: Systematic review and meta-analysis of randomized controlled trials. Ultrasound Obstet Gynecol 2017;50(5):578-83. [CrossRef] google scholar
• 10. Stegwee SI, Jordans IPM, Van der Voet LF , van de Ven PM, Ket JCF, Lambalk CB, et al. Uterine caesarean closure techniques affect ultrasound findings and maternal outcomes: A systematic review and meta-analysis. BJOG 2018;125(9):1097-108. [CrossRef] google scholar
• 11. Roberge S, Demers S, Girard M, Vikhareva O, StephanieM, Chaillet N et al. Impact of uterine closure on residual myometrial thickness after cesarean: A randomized controlled trial. Am J Obstet Gynecol 2016;214(4):507.e1-507.e6. [CrossRef] google scholar
• 12 Bamberg C, HinksonL, Dudenhausen JW, Bujak V, Kalache KD, Henrich W. Longitudinal transvaginal ultrasound evaluation of cesarean scar niche incidence and depth in the first two years after single- or double-layer uterotomy closure: A randomized controlled trial. Acta Obstet Gynecol Scand 2017;96(12):1484-9. [CrossRef] google scholar
• 13. Vachon-Marceau C, Demers S, Bujold E, Roberge S, Gauthier RJ, Pasquier JC, et al. Single versus double-layer uterine closure at cesarean: Impact on lower uterine segment thickness at next pregnancy. Am J Obstet Gynecol 2017;217(1):65.e1-65.e5. [CrossRef] google scholar
• 14. Hesselman S, Högberg U, Ekholm-Selling K, Râssjö E-B, Jonsson M. The risk of uterine rupture is not increased with single-compared with double-layer closure: A Swedish cohort study. BJOG 2014;122(11):1535-41. [CrossRef] google scholar
• 15. Sumigama S, Sugiyama C, Kotani T, Hayakawa H, Inoue A, Mano Y, et al. Uterine sutures at prior caesarean section and placenta accreta in subsequent pregnancy: A case-control study. BJOG 2014;121(7):866-75. [CrossRef] google scholar
• 16. Yilmaz Baran S, Kalayci H, Dogan Durdag G, YetkinelS, Alemdaroglu S, Cok T, et al. Single- or double-layer uterine closure techniques following cesarean: A randomized trial. Acta Obstet Gynecol Scand 2021;100(3):531-7. [CrossRef] google scholar
• 17. Bennich G, Rudnicki M, Wilken-Jensen C, Lousen T, Lassen PD, Wojdemann K. Impact of adding a second layer to a single unlocked closure of a Cesarean uterine incision: Randomized controlled trial. Ultrasound Obstet Gynecol 2016;47(4):417-22. [CrossRef] google scholar
• 18. Hegde CV. The never ending debate single-layer versus double-layer closure of the uterine incision at cesarean section. J Obstet Gynaecol India. 2014;64(4):239-40. [CrossRef] google scholar
• 19. Festing MFW, Altman DG. Guidelines for the design and statistical analysis of experiments using laboratory animals. ILAR J 2002;43(4):244-58. [CrossRef] google scholar
• 20. Percie du Sert N, Ahluwalia A, Alam S, Avey MT, Baker M, Browne WJ, et al. Reporting animal research: Explanation and elaboration for the ARRIVE guidelines 2.0. PLoSBiol 2020;18(7):e3000411. [CrossRef] google scholar
• 21. Rozenberg P, Senat MV, Deruelle P, et al. Evaluation of the usefulness of ultrasound measurement of the lower uterine segment before delivery of women with a prior cesarean delivery: A randomized trial. Am J Obstet Gynecol 2022;226(2):253.e1-253.e9. [CrossRef] google scholar
• 22. K Bolten, T Fischer, Y Y-N Bender, G Diederichs, A Thomas. Pilot study of MRI/ultrasound fusion imaging in postpartum assessment of Cesarean section scar. Ultrasound Obstet Gynecol 2017;50(4):520-6. [CrossRef] google scholar
• 23. Bujold E, Bujold C, Hamilton EF, Harel F, Gauthier RJ. The impact of a single-layer or double-layer closure on uterine rupture. Am J Obstet Gynecol 2002;186(6):1326-30. [CrossRef] google scholar
• 24. Morris H. Surgical pathology of the lower uterine segment google scholar
• 25. Wu C, Chen X, Mei Z, Zhou J, Wu L, Chiu WH, et al. A google scholar
• 26. Roeder HA, Cramer SF, Leppert PC. A look at uterine wound healing through a histopathological study of uterine scars. Reprod Sci 2012;19(5):463-73. google scholar
• 27. caesarean section scar: Is the scar a source of clinical symptoms? Int J Gynecol Pathol 1995;14(1):16-20. [CrossRef] google scholar
• 28. Vervoort A, Uittenbogaard LB, Hehenkamp WJK, Brölmann HAM, Mol BWJ, Huirne JAF. Why do niches develop in caesarean uterine scars? Hypotheses on the aetiology of niche development. Hum Reprod 2015;30(12):2695-702. [CrossRef] google scholar