title: Purse-string double-layer closure: a novel technique for repairing the uterine incision during cesarean section.
abstract: OBJECTIVE
  To compare the classical double-layer uterine closure to a double-layer purse-string uterine closure (Turan technique) in cesarean section regarding short- and long-term results.
  
  
  METHODS
  Patients were randomized into either the double-layer purse-string uterine closure arm (study group, 84 patients) or the classical double-layer uterine closure arm (control group, 84 patients). For short-term comparison, a detailed transvaginal ultrasound examination was planned in all patients 6 weeks after the operation and a wedge-shaped defect in the uterine incision scar was accepted as uterine scar defect and recorded. For the long-term comparison, subsequent pregnancies of these patients were followed up for any complication.
  
  
  RESULTS
  The number of patients with ultrasonographically visible uterine scar defect was 12 (23.5% of all scar defects) in the study group whereas it was 39 (76.5% of all scar defects) in the control group (P < 0.001, χ(2) = 15.42). Demographic data, operation time, hospitalization time, preoperative and postoperative hemoglobin values were not significantly different between the groups. During the 2-year of the follow-up period, five patients in the study group and six patients in the control group became pregnant again. No complication during their pregnancies and second cesarean operation were encountered.
  
  
  CONCLUSIONS
  With the Turan technique, the uterine incision length becomes shorter, and the frequency of uterine scar defect is lower regarding short-term results. More data is needed for long-term results. ClinicalTrials.gov NCT01287611.
authors.affiliation: Department of Obstetrics and Gynecology, Dr Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey.
authors.forename: Cem
authors.initials: C
authors.lastname: Turan
authors.forename: Esra Esim
authors.initials: EE
authors.lastname: Büyükbayrak
authors.forename: Aylin Onan
authors.initials: AO
authors.lastname: Yilmaz
authors.forename: Yasemin Karageyim
authors.initials: YK
authors.lastname: Karsidag
authors.forename: Meltem
authors.initials: M
authors.lastname: Pirimoglu
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000379:methods*; D005260:Female; D006801:Humans; D061646:Operative Time; D011247:Pregnancy; D013536:Suture Techniques; D016896:Treatment Outcome; D014599:Uterus / Q000601:surgery*
keywords: cesarean section; purse-string closure; scar defect; surgical technique