Less is more—a minimal approach technique for Cesarean Section

Abstract

Less is more—a minimal approach technique for Cesarean Section Dragan Belci1,2, *, Gian Carlo Di Renzo2,3 , Davor Zoričić1 , Andrea Tinelli4,5 , Antonio Malvasi6 , Michael Stark2 1Department of Gynaecology and Obstetrics, General Hospital Pula, 52100 Pula, Croatia 2 The New European Surgical Academy (NESA), 10117 Berlin, Germany 3Department of Obstetrics and Gynecology and Center for Perinatal and Reproductive Medicine, Santa Maria della Misericordia University Hospital, 06129 Perugia, Italy 4Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Vito Fazzi Hospital, 73100 Lecce, Italy 5Department of Obstetric and Gynecology, Veris delli Ponti Hospital, 73020 Scorrano, Lecce, Italy 6Department of Obstetrics and Gynecology, "Santa Maria" Hospital, G,V,M, Care & Research, 70124 Bari, Italy *Correspondence: dragan.belci@gmail.com (Dragan Belci) DOI:10.31083/j.ceog.2021.03.2422 This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/). Submitted: 16 December 2020 Revised: 20 March 2021 Accepted: 29 March 2021 Published: 15 June 2021 Background: The various techniques for performing a Cesarean Section (CS) have a long history. There are numerous surgical variations based on personal or local tradition, but these are not based on evidence and often have different outcomes on maternal and newborn health. Many modifications of the CS technique have been utilized in order to improve outcome with variable results both positive and negative. Several CS laparotomic methods have been developed but no consensus has been reached on the most optimal approach as related to safety and morbidity. Methods: The minimalistic approach of the Stark Cesarean Section (SCS) is compared to other methods thorugh an evaluation of the studies published in the last 20 years comparing this technique with others, the systematic reviews and the personal experience of the authors. Results and discussion: The abdominal incision done at the Stark Cesarean Section differs from the Pfannenstiel incision by its location being above the arcuate line eliminating the need to separate the fascia from the recti muscles. The muscle separations being away from the pubic bone and the iliohypogastric and ilioinguinal nerves eliminates the risk of damage. This unique surgical approach is a logical, fast and simple one that eliminates unnecessary operative steps saving time and reducing complications. After fifteen years of experience and thousands of SCS performed at our departments, we may conclude that this method has several advantages over other surgical methods as related to short and long-term outcomes, including chronic/neuropathic pain and quality of life. Keywords Misgav Ladach cesarean; Stark Cesarean Section (SCS); Techniques of Cesarean Section; Chronic pain