title: Caesarean section: could different transverse abdominal incision techniques influence postpartum pain and subsequent quality of life? A systematic review.
abstract: The choice of the type of abdominal incision performed in caesarean delivery is made chiefly on the basis of the individual surgeon's experience and preference. A general consensus on the most appropriate surgical technique has not yet been reached. The aim of this systematic review of the literature is to compare the two most commonly used transverse abdominal incisions for caesarean delivery, the Pfannenstiel incision and the modified Joel-Cohen incision, in terms of acute and chronic post-surgical pain and their subsequent influence in terms of quality of life. Electronic database searches formed the basis of the literature search and the following databases were searched in the time frame between January 1997 and December 2013: MEDLINE, EMBASE Sciencedirect and the Cochrane Library. Key search terms included: "acute pain", "chronic pain", "Pfannenstiel incision", "Misgav-Ladach", "Joel Cohen incision", in combination with "Caesarean Section", "abdominal incision", "numbness", "neuropathic pain" and "nerve entrapment". Data on 4771 patients who underwent caesarean section (CS) was collected with regards to the relation between surgical techniques and postoperative outcomes defined as acute or chronic pain and future pregnancy desire. The Misgav-Ladach incision was associated with a significant advantage in terms of reduction of post-surgical acute and chronic pain. It was indicated as the optimal technique in view of its characteristic of reducing lower pelvic discomfort and pain, thus improving quality of life and future fertility desire. Further studies which are not subject to important bias like pre-existing chronic pain, non-standardized analgesia administration, variable length of skin incision and previous abdominal surgery are required.
authors: Department of Women's and Children's Health-University of Padua, Padua, Italy.
authors: Salvatore
authors: S
authors: Gizzo
authors: Department of Women's and Children's Health-University of Padua, Padua, Italy.
authors: Alessandra
authors: A
authors: Andrisani
authors: Department of Women's and Children's Health-University of Padua, Padua, Italy.
authors: Marco
authors: M
authors: Noventa
authors: Department of Women's and Children's Health-University of Padua, Padua, Italy.
authors: Stefania
authors: S
authors: Di Gangi
authors: Department of Obstetrics and Gynecology, University of Verona, Verona, Italy.
authors: Michela
authors: M
authors: Quaranta
authors: Department of Women's and Children's Health-University of Padua, Padua, Italy.
authors: Erich
authors: E
authors: Cosmi
authors: Department of Women's and Children's Health-University of Padua, Padua, Italy.
authors: Donato
authors: D
authors: D'Antona
authors: Department of Women's and Children's Health-University of Padua, Padua, Italy.
authors: Giovanni Battista
authors: GB
authors: Nardelli
authors: Department of Women's and Children's Health-University of Padua, Padua, Italy.
authors: Guido
authors: G
authors: Ambrosini
mesh_terms: D000005:Abdomen / Q000294:innervation / Q000601:surgery*; D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D010149:Postoperative Pain / Q000209:etiology*; D049590:Postpartum Period; D011788:Quality of Life
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