Caesarean Closure TechniqueMy goal is not only for you to have an enjoyable Caesarean section delivery experience but also for you to have the least postoperative discomfort possible and an excellent long to recovery with excellent healing.

While there are many variables that can account for differences in recovery, I believe taking time and care with closure and in particular closing, the uterus and all layers of the abdominal wall is a major factor.

I am “fussy” and neat person by nature and to be as careful with the closure of the uterus and abdominal wall is consistent with my personality

I insert eight layers of stitching in closure with a Caesarean section. These are:

  1. Uterus muscle in two layers of continuous suture. With the first layer, I avoid stitches going into the endometrium (called decidua in pregnancy) and so minimise the risk of placenta accreta (placenta morbidly adherent to or embedded in the uterine wall) in the next pregnancy.
  2. Visceral peritoneum (skin over uterus) with a continuous suture.
  3. Parietal peritoneum (inner skin of abdominal wall) with a continuous suture.
  4. Muscle layer (rectus abdominis or ‘abs’) with interrupted sutures to help give you a ‘flat tummy’.
  5. Rectus sheath with a continuous suture.
  6. Subcutaneous fat with a continuous suture.
  7. Skin with a continuous subcuticular absorbable suture.

Closing all the layers also minimises the risk of adhesions (tissues abnormally adherent to other tissues). Such adhesions can involve omentum (fatty visceral peritoneum layer) or even small bowel being stuck to abdominal wall. This increases risk of subsequent surgery considerably.

When I find adhesions from previous surgery I spend extra time ‘tidying up’ the patient up by freeing adhesions when safe to do so and then take care with closure. It is not unusual for a patient in whom I find and correct adhesions to comment to me postoperative that she feels so much better than she did before.

I know that extra time and care with closure is worth it!

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