Does Extra Peritoneal LSCS have any Advantage over Conventional LSCS?

INTRODUCTION

Caesarian Section is the procedure carried out to deliver one or more fetus through the opening of the abdomen [Laparotomy] and the Uterus [Hysterectomy]. German gynecologist Federnand Adolf Kehrer was the first person to describe the modern LSCS [1]. He performed the first Caesarian section in Germany in 1881. The commonly used Pfannenstiel incision was described in 1900. The caesarian section rate is less than 4 in African countries and 1.8 in Nigeria while in the developed countries it could be as high as 30% [2].

The various types of caesarean sections are;

• Classical Caesarean Section
• Lower Segment Transperitoneal
• Extraperitoneal Lower Segment

Extraperitoneal Lower Segment C/S is a method of surgical delivery of fetuses through an incision in the lower uterine segment without entering the peritoneal cavity. The uterus is approached through the Retro-Vesical from paravesical space. This procedure is originally performed most often to prevent spread of infection from the uterus into the peritoneal cavity. Though, it takes longer time to perform than trans-peritoneal lower segment caesarean section.

ADVANTAGES OF EXTRAPERITONEAL CAESAREAN SECTION

1. The post operative pain is less because the peritoneum is not incised.
2. Post operative stay is short and many could be discharged in less than 24 hours.
3. The patients can take orally after the effect of anaesthesia wears off.
4. Due to small space below the public symphysis, hemostasis is easily achieved by the use of gauze pack when bleeding points cannot be easily identified.
5. Intra-peritoneal soiling is prevented.
6. Economic advantage includes; limited use of Intravenous fluids, analgesics, hospital toiletries, sutures and beddings.
7. Late complication of adhesive intestinal obstruction is prevented completely.
8. It is the best for immune-comprised patients such as HIV/AIDS patients.
9. Even with problem of sub-hepatic abscess, peritoneum is intact immediate post operative.
10. Patients with Eclampsia and severe pre-eclampsia can start oral medication as soon as anesthesia is over.
11. Hover tubal obstruction is as slow as in septic vaginal delivery. What this means is that fertility is nowhere threatened by extra-peritoneal caesarean section. As it is threatened by the common CS method.
12. No post-operative hernia has been recorded so far although it is possible with poorly skilled surgeons.

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