Caesarean section is considered one of the most common operations, which should be able to do not only an obstetrician-gynecologist, but also every doctor who specializes in conducting operations. Every woman dreams of having a baby with this operation, as this is a less painful way than the conventional one. It is worthwhile to figure out how the operation of Caesarean section according to Joel Cohen, and in other methods.
What is the essence of the operation?
The essence of the caesarean section is that a transverse section is made in the lower abdomen, from where the fetus is removed. This is usually done when the baby is born prematurely, or when mechanical damage has been done outside. However, it can be done when the family wants to give birth to their child in this way - this is not a ban.
Caesarean section may be negative. So after the operation, a woman can develop infertility, malfunctioning of the hormonal system and, of course, pain, because of which it is often not even possible to breastfeed her baby. During the postoperative period, a woman may experience bleeding due to seam divergence, constant aching pain, infection, pulmonary embolism and peritonitis. All this is due to the fact that the body did not fulfill its function, which was prepared for nine months with the correct course of pregnancy, which makes us aware.
Each doctor is simply obliged to accurately determine the body of the future mother and say whether she can count on a cesarean section or not. However, modern medicine has already taken into account those cases when this operation is contraindicated for a woman, but at the same time, giving birth to a child without it is simply impossible. Therefore, improved techniques have been developed, including a Joel-Cohen laparotomy.
Operation
Despite the large number of pluses, Pfannenstiel laparotomy has drawbacks that significantly affect the health of not only the mother, but also the fetus. So when pulling the fetus, problems with the passage of the head, shoulders and pelvis, if it is quite large, may appear. In the case of the mother, there may be problems with the vessels that were involved during the operation, frequent hematomas and various injuries of organs located in the lower abdomen. Also, this method can bring its consequences during the second pregnancy or even bearing a child, since the seam can still not fully heal.
As a result, several new methods have been developed, the purpose of which is to reduce the pain and negativity of the consequences, and the time of the operation. They differ both in that they are performed with blunt objects, and with all the technique. This is the slope of the section, its location, length, depth and other important parameters.
Joel-Cohen Technique
The best option for a cesarean operation is the Joel-Cohen technique. An equal transverse surface section is made according to Joel Cohen at cesarean section, below the line connecting the axes of the bones. On average, the distance between the line and the notch should be 2.5 centimeters, however, depending on the structural features of the body and the condition of the woman, the length can be changed by the treating doctor.
Next, an incision is made with a scalpel, deepening it up to the manifestation of aponeurosis. After that, the last is made notches on the sides, without touching the white line. Notched aponeurosis stretch the ends of the scissors to the sides. It is important that this stretching occurs under the subcutaneous fat - so there will be a chance that after the operation, the woman will be able to again give birth to a child using cesarean section.
The doctor must open different muscles alternately in different ways. So, straight lines are stretched in a blunt way, for example, with the same edges of straight scissors. After the opening of the parietal peritoneum, the muscles and fiber are opened by bilateral traction. The peritoneum itself can be stretched both with muscles and fiber, or separately with the fingers in the opposite direction horizontally.
Methodology Efficiency
It can be concluded that the cut using Joel-Cohen technology is more versatile and convenient than Pfannenstil. This is primarily due to the fact that the operation is much faster and the stretching of the muscles and peritoneum is not accompanied by bleeding. It is also noticeable that the peritoneum itself is stretched laterally, parallel to the incision itself, while the aponeurosis does not exfoliate.
It can also be noted that when using the Joel-Cohen technique, the branches of the vessels located inside and near the genitals remain intact and not cut, which is not observed in the Pfannenstiel method. This is due to the fact that all stretchings are made by blunt objects in the corners of the side incisions, which indicates a higher level of such an operation.
During the Joel - Cohen operation, vessels are not damaged, which are associated with aponeurosis by penetrating them into the rectus muscles, due to the remote stage of exfoliation using aponeurosis incisions. As a result, after surgery, all wounds heal much faster, because only incisions were made in the corners and the incision itself. And since they are less mobile and are not used as vessels penetrating the muscles of the aponeurosis, the likelihood of bleeding after the birth of a child will be much less.
During repeated operations of giving birth to a child, in particular, Caesarean section, no complications are observed, which could have manifested themselves with the usual technique. Also, the likelihood that a woman may become infertile or have problems with the secretion and functioning of hormones also disappears.
Postoperative period
The postoperative period when applying the Joel-Cohen method of gluttony is characterized by less pain, as a result of which the number of analgesics used is significantly reduced or even equal to zero.
In particular, this is due to the fact that the number of seams is almost half as much as after using any other method. Also, with this type of laparotomy according to Joel - Cohen, the probability of the appearance of infectious diseases and the formation of hematomas in the front of the abdomen is reduced by half. This method is also convenient for most doctors, since the duration of the operation is reduced by one and a half times.
Method Advantages
Following from all this, the following advantages of the Joel-Cohen method can be noted:
- Less chance of injury due to stretching of all muscles and the peritoneum, as well as the presence of only two incisions on the sides, one large incision and not affecting the aponeurosis.
- Reduced bleeding due to fewer sutures (almost one and a half times), without affecting the branches of blood vessels and cutting less used muscles.
- A significant part of the time is saved due to the fact that all the muscles and the peritoneum are not cut, but are stretched by blunt objects (the edges of straight scissors) and fingers - literally in the second minute the fetus already gets.
- The simplicity of the entire operation allows it to be performed not only by obstetrician-gynecologists, but also by other doctors who have permission to conduct operations, as well as interns, due to which several operations can be performed simultaneously, if the number of operating rooms in the hospital allows.
- The risk of injury to organs located near the uterus is reduced, because the peritoneum is stretched by the doctor’s fingers, and not cut with a scalpel.
- In the postoperative period, the risk of complications, infectious diseases and hematomas in the peritoneal region is reduced.
- The risk of infertility in a woman is reduced, as well as a malfunction in the production of hormones and the flow of menstrual cycles.
This type of laparotomy according to Joel-Cohen is used in medical practice not only by obstetrician-gynecologists, but also by trainees. According to statistics, in emergency situations it is he who is used, and not the Pfannenstiel method, which is more painful and dangerous after the operation. The UK association has proclaimed that this technology will soon be used in training medical professionals so that they immediately take on the method that will bring a more favorable result.
Suture material
In modern medicine, several materials are used that are used in various situations. They are necessarily used in the healing of large wounds, cuts and incisions that remain after surgery, because with their help all this heals much faster and reduces the likelihood that the wound will open and begin to bleed.
Synthetic absorbable thread
It is this type of medical thread that is used in obstetrics after childbirth and cesarean section surgery. All incisions, muscles, peritoneum, and also aponeurosis are sutured with it. When using the Joel-Cohen method, only the side cuts made before stretching, as well as the cross cut on the abdomen, are sutured with synthetic absorbable thread.
Unfortunately, on the fifth day after suturing all cuts, inflammation is observed, which lasts about a month. It is noticed that on about the twenty-eighth day it passes if there is maxon or polydioxanone in the thread, which is in the synthetic absorbable thread.
Also, its advantage is observed in the following:
- On about the tenth day, many types of materials begin to lose their strength, and after a month the woman has to go to the hospital so that the doctors inflicted new sutures. When using a synthetic absorbable thread, there is no such problem, since it holds its strength up to the complete healing of cuts.
- When using a synthetic absorbable thread, which has only Maxson in its composition, the healing period of cuts is much faster. Polydioxanone is used when a woman detects diseases that were before pregnancy.
- This thread has a low reactogenicity, which also has a positive character - cuts during healing do not fester, do not diverge and inflammation goes much faster.
- The use of a synthetic absorbable thread does not bear any undesirable consequences in the form of infectious diseases, suppurations, or malfunctioning hormones.
Other advanced caesarean section techniques
There are many techniques for performing cesarean section, which, of course, have their advantages. After all, one action, done not according to a certain technique, already has its own result, unlike the others. Therefore, every obstetrician-gynecologist who is not afraid to bring his developments to reality can create his own method.
Pfannenstiel Laparotomy
This type of operation has its huge drawback - because of the huge number of incisions, many caesarean sutures are placed, which also threaten to disperse, and there is severe bleeding, which is why it is difficult to carry out the operation. However, if you already know how to make incisions and remember where exactly they should be, the operation can be carried out quickly, without taking into account the constant allocation of blood.
All of several seams are sutured to prevent them from opening, but as a result, everything heals for a very long time, and the aching pain does not recede for a long time, which is why the woman has to drink analgesics.
Misgav Lada technique
Misgav-Ladah laparotomy has an advantage over the previous one in less bleeding, surgery time and postoperative complications and pain. Also, when sewing cuts, less sewing material is used, as a result of which the woman is not threatened with suppuration of wounds.
The essence of the method is that after an incision, the abdominal cavity is cut, the muscles before that are cut with scissors on the sides, the placenta is separated in a blunt manner, and the uterus is pulled out with the fingers. All sections, as in the Joel-Cohen method, are transverse. This is the advantage of a caesarean section of this type over the first.
Conclusion
As you can see, there are a lot of ways how the operation is performed with cesarean section. This is not just an operation to remove the fetus from the uterus. This is a great opportunity for women to give birth to a baby painlessly, subsequently having only a few cuts and seams inside and one outside. It is often used when the fetus has been damaged by an external factor, such as a blow to the stomach or a fall. In addition, cesarean section is an excellent solution for the almost painless birth of a child to those women who suffer from an increased pain threshold. But most popular according to Joel-Cohen.
Laparotomy in this way is an advanced technique for cesarean section, which has several advantages compared to their own kind. This is not significant blood loss, and the minimum amount of thread application, a decrease in the possibility of developing infectious diseases and the appearance of hematomas in the peritoneum, and not fear as a result of finding infertility or malfunctioning of the hormonal system. The technique is very popular, as it suits almost all women. In addition, after its use, it is possible to give birth to a child again, using a caesarean section.