Extraperitoneal cesarean, is it safe and comfortable?

INTRODUCTION: We aimed to show that extraperitoneal cesarean delivery (EPCD) is more advantageous than trans peritoneal cesarean delivery (TPCD).
METHODS: Sixty cases analyzed either EPCD or TPCD were included in this study. Patients with suspected placental invasion anomalies (placenta accreta, increta or percreta), placenta previa, a history of midline uterine incision, multiple pregnancies, previous cesarean section, previous major abdominal surgery, delivery before 34 weeks of gestation or fetal macrosomia (estimated fetal weight >4500 g) were excluded. The endpoints were the duration of the operation, nausea and vomiting during the operation, postoperative nausea and vomiting, the number of analgesic medications, postoperative shoulder pain, postoperative gas/stool discharge time, complete blood count (CBC), urinary dysfunction, and neonatal outcomes.
RESULTS: TPCD patients suffered significantly more intraoperative nausea (10% vs. 33.3%, p: 0.03) and postoperative vomiting (0% vs. 13.3%, p: 0.04) compared to TPCD group. There was no significant difference in intraoperative vomiting and postoperative nausea rates between the two groups (p: 0,282). The duration of the operation was shorter in TPCD than EPCD groups (25,5 minutes vs. 28,7 minutes, p=0.01). After the operation, significantly fewer analgesic drugs were used in the EPCD than the TPCD groups (p: 0.01). The duration between defecation and operation was significantly shorter in the EPCD group compared to TPCD group (p: 0,042).
DISCUSSION AND CONCLUSION: EPCD reduces postoperative pain, analgesic requirement, nausea, vomiting, and bowel dysfunction in cesarean patients without an increase in significant complications.