Comparative analysis of long-term outcomes of Misgav
Ladach technique cesarean section and traditional
cesarean section
Ata Ghahiry
1
, Farimah Rezaei
2
, Reza Karimi Khouzani
1
and Mansoor Ashrafinia
3
1
Department of Obstetrics and Gynecology, Isfahan Medical School,
2
Department of Obstetrics and Gynecology, Alzahra
University Hospital, Isfahan University of Medical and Health Services (IUMS), Esfahan, and
3
Department of Obstetrics and
Gynecology, Arash University Hospital, Tehran University of Medical Sciences (TMUS), Tehran, Iran
Abstract
Aim: The aim of the present study was to evaluate pelvic adhesions, dehiscence and chronic pelvic pain in two
groups of patients who underwent different cesarean section (CS) operations.
Material and Methods: One hundred and twelve eligible patients who met our criteria were randomly
divided into two groups. Group 1 consisted of 52 women who had been operated at their first CS by
Misgav Ladach technique and had now undergone a second CS. Group 2 consisted of 60 women who
had been operated at their first CS by traditional (Pfannenstiel) technique and had now undergone a second
CS. The two groups were compared for long-term outcomes, including adhesion, pelvic pain and wound
dehiscence.
Results: The rate of adhesion in group 2 was 50% filmy type and 1.7% dense type. However, in group 1 the
adhesion rate was 50% filmy and there was no dense type (P = 0.12). The location of adhesions were signifi-
cantly different (P = 0.04). Dehiscence of uterine incision in the second group was seen in three patients but no
dehiscence was found in the first group (P = 0.012). The rate of chronic pelvic pain in Misgav Ladach group
(group 1) was 17.2% versus 35% in the traditional method (P = 0.01).
Conclusion: The present results support the method of single layer suturing of the uterus and leaving the
peritoneum intact in CS.
Key words: adhesion, cesarean section, dehiscence, Misgav Ladach, traditional.
Introduction
In 1972 a new method of cesarean section (CS) was
suggested by Joel Cohen. This method included single
layer suturing of the uterus and leaving the perito-
neum intact.
1
Cheong et al.
2
concluded that short-term morbidity
of CS is not related to non-closure of the peritoneum.
Studies on the effects of closure or non-closure of the
peritoneum during cesarean delivery on adhesion for-
mation have concluded that insufficient data was avail-
able and that adequately powered and designed trials
were needed.
3
In an attempt to simplify the traditional (Pfannen-
stiel) CS as well as to achieve less tissue damage
through the elimination of superfluous steps, the
Joel Cohen method was modified by Stark et al.at
Misgav Ladach General Hospital in Jerusalem, leading
to a unique improvement of the Misgav Ladach
method (MLM). Moreover, MLM was composed of a
Pfannenstiel incision for opening the abdomen fol-
lowed by suturing of the uterus in one layer, and
Received: December 21 2010.
Accepted: September 17 2011.
Reprint request to: Dr Reza Karimi Khouzani, Department of Obstetrics and Gynecology, Isfahan Medical School, Isfahan University
of Medical Sciences and Health Services (IUMS), Hezar Jarib Street, Azadi SQ., Esfahan 81746, Iran. Email: rezakarimi.kh@irimc.org
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doi:10.1111/j.1447-0756.2011.01777.x J. Obstet. Gynaecol. Res. Vol. 38, No. 10: 1235–1239, October 2012
© 2012 The Authors 1235
Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology