title: A randomized comparative study on modified Joel-Cohen incision versus Pfannenstiel incision for cesarean section.
abstract: OBJECTIVE
  Pfanennstiel incision is the most commonly used incision for cesarean section, but may not be the best. This study compared the modified Joel-Cohen incision with the Pfannenstiel incision to evaluate whether techniques to open the abdomen might influence operative time, and maternal and neonatal outcomes.
  
  
  METHODS
  In a randomized comparative trial, 302 women with gestational age >34 weeks, requiring cesarean section, were randomly assigned to either modified Joel-Cohen incision or Pfannenstiel incision for entry into the peritoneal cavity. The primary outcome measure was total time required for performing operation and secondary outcome measures were baby extraction time, number of haemostatic procedures used in the abdominal wall, postoperative morbidity, postoperative hospital stay and neonatal outcome.
  
  
  RESULTS
  Mean total operative time was significantly less in the modified Joel-Cohen group as compared to the Pfannenstiel group (29.81 vs 32.67 min, p<0.0001, 95%CI=2.253 to 3.467). Time taken to deliver the baby and haemostatic procedures required during operation were also significantly less in the modified Joel-Cohen group as compared to the Pfannenstiel group. Requirement of strong analgesics was higher in the Pfannenstiel group (53.64% vs 21.85%, p<0.0001). There was no statically significant difference in the incidence of postoperative wound complications but postoperative stay in hospital was significantly less in the modified Joel-Cohen group (p=0.002). Neonatal outcomes were similar in both groups.
  
  
  CONCLUSIONS
  The modified Joel-Cohen incision for entry into peritoneal cavity during cesarean section is associated with reduced mean total operative and baby extraction times with less postoperative pain and shorter hospital stay, which may be beneficial and cost effective.
authors.affiliation: Department of Obstetrics and Gynecology, North Bengal Medical College, Darjeeling, West Bengal, India.
authors.forename: Shyama Prasad
authors.initials: SP
authors.lastname: Saha
authors.affiliation: Department of Obstetrics and Gynecology, R. G. Kar Medical College, Kolkata, West Bengal, India.
authors.forename: Nabendu
authors.initials: N
authors.lastname: Bhattarcharjee
authors.affiliation: Department of Obstetrics and Gynecology, R. G. Kar Medical College, Kolkata, West Bengal, India.
authors.forename: Sabysachi
authors.initials: S
authors.lastname: Das Mahanta
authors.affiliation: Department of Obstetrics and Gynecology, R. G. Kar Medical College, Kolkata, West Bengal, India.
authors.forename: Animesh
authors.initials: A
authors.lastname: Naskar
authors.affiliation: Department of Obstetrics and Gynecology, North Bengal Medical College, Darjeeling, West Bengal, India.
authors.forename: Sanjoy Kumar
authors.initials: SK
authors.lastname: Bhattacharyya
keywords: Cesarean section; Pfannenstiel; incision; modified Joel-Cohen; operative time