P152Post‐cesarean sonographic evaluation of subfascial hematoma in Joel‐Cohen and pfannenstiel laparotomies: 5 years of experience

BackgroundIn this prospective randomized study, some elements of morbidity between Joel‐Cohen laparotomy (J.‐C.‐l.) and Pfannenstiel laparotomy (P.‐l.) have been evaluated. Using transabdominal sonography pathologic subfascial hematomas have been searched for in 258 cesarean section (c.s.) with J.‐C.l. and in 292 c.s. with P.l. We've examined 238 first c.s. (83.50%) and 47 repeat c.s. (16.49%) carried out through J.‐C.l., while 253 first c.s. (86.05%) and 39 repeat (13.26%) through P.l.ResultThe abdominal wall of the patients who underwent c.s. was examined sonographically on the 3rd and 10th postoperative day, considering anechogenic areas, with clear wall, with interior echoes, both subfascial with a diameter more than 3 centimetres long. At c.s. through J.C.l. we have observed 3 subfascial hematomas (1.75%) (2 surgical treatment) compared to 5 (2.72%) through P.l., (3 surgical treatment) with no statistical significancy. On the contrary statistically significant differences have been observed whith regard to opening and closing time of abdominal wall; 4.9 min for J.‐C.l. and 14.7 min for P.l. (P < 0.05), as all operating time.ConclusionIn conclusion, in our clinical and sonographic experience, at first c.s. P.l. does not cause a greater formation of abdominal wall hematomas compared to J.‐C.l. as Stark refers, it is clear that surgical and anaesthesiological time lengthens, suture materials increase with P.l. At repeat c.s. stretching is not always easy, because of the cicatricial condition of the muscles besides an exaggerate manipulation of the tissues may favour subfascial hematomas. In the J.‐C.l. the subfascial‐hematoma occurs the blood invades the peritoneal cavity changing the clinical and sonographic situation compared to classic subfascial hematoma with closed peritoneum.