Laparotomy according to Joel-Cohen. Improvements in the caesarean section technique

2024 Author: Priscilla Miln | [email protected]. Last modified: 2023-12-16 00:21

Caesarean section is considered one of the most common operations that not only an obstetrician-gynecologist should be able to do, but every doctor who specializes in operations. Every woman dreams of giving birth to a child through this operation, as this is a less painful method than the conventional one. It is worth figuring out how a caesarean section works according to Joel Cohen, and in other ways.

What is the essence of the operation?

The essence of a caesarean section is that a transverse incision is made in the lower abdomen and the fetus is removed from there. This is usually done when the baby is born prematurely, or when mechanical damage has been done from the 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 can be negative. So after the operation, a woman may develop infertility, hormonal system failures and, of course, pain, due to which it is often not even possible to feed her child.breast. During the postoperative period, a woman may experience bleeding due to rupture of the suture, constant aching pain, infection, pulmonary embolism and peritonitis. All this is due to the fact that the body did not fulfill its function, for which it was preparing for nine months with the correct course of pregnancy, which it lets you know.

Every doctor is simply obliged to accurately determine the body of the expectant mother and say whether she can count on a caesarean 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, the birth of a child without it is simply impossible. Therefore, improved techniques have been developed, including the Joel-Cohen laparotomy.

Operation

Laparotomy according to Pfannenstiel, despite the large number of advantages, has disadvantages that significantly affect the he alth of not only the mother, but also the fetus. So when the fetus is pulled out, problems may arise with the passage of the head, shoulders and pelvis, if it is of a rather large size. In the case of the mother, there may be problems with the vessels that were involved during the operation, frequent hematomas and various injuries to the 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 may still not fully heal.

As a result, several new methods have been developed, the purpose of which is to reduce the pain and negative consequences, and the time of the operation. They arediffer both in that they are performed with blunt objects, and in all equipment. These are the slope of the cut, its placement, length, depth and other important parameters.

Joel-Cohen technique

The best caesarean option is the Joel-Cohen method. A smooth transverse superficial incision is made according to Joel Cohen during caesarean section, below the line of connection of the axes of the bones. On average, the distance between the line and the incision should be 2.5 centimeters, however, depending on the structural features of the body and the condition of the woman, the length may be changed by the attending doctor.

Next, an incision is made with a scalpel, deepening it until the manifestation of the aponeurosis. After that, on the latter, notches are made on the sides, without touching the white line. The incised aponeurosis is stretched with 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 give birth to a child again by caesarean section.

Different muscles the doctor must open alternately in different ways. So, straight lines are stretched in a blunt way, for example, by the same edges of straight scissors. After the opening of the parietal peritoneum, the muscles and tissue are opened by the method of bilateral traction. The peritoneum itself can be stretched both with muscles and fiber, and separately with the help of fingers in the opposite direction horizontally.

Efficiency of the methodology

It can be concluded that the Joel-Cohen incision is moreuniversal and convenient than Pfannenstiel. 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 transversely, parallel to the incision itself, and the aponeurosis does not exfoliate.

It can also be noted that when using the Joel-Kohen technique, the branches of the vessels located inside and near the genitals remain untouched and not cut, which is not observed in the Pfannenstiel method. This is due to the fact that all stretching is done with blunt objects at the corners of the side incisions, which indicates a higher level of such an operation.

During the operation according to Joel-Kohen, the vessels that are associated with the aponeurosis are not damaged by penetrating them into the rectus muscles, due to the remote stage of exfoliation using incisions in the aponeurosis. As a result, after the operation, all wounds heal much faster, because only notches were made in the corners and the incision itself. And since they are less mobile and not used as vessels penetrating the muscles from the aponeurosis, the likelihood of bleeding after the birth of a child will be much less.

During repeated operations for the birth of a child, in particular by caesarean section, there are no complications that could occur with the usual technique. It also eliminates the possibility that a woman may become infertile or have problems with the secretion and work of hormones.

Post-operative period

The postoperative period when using the Joel-Kohen method of abdominal dissection is characterized byless pain, resulting in the amount of analgesics used is significantly reduced or even equal to zero.

In particular, this is due to the fact that the number of stitches is almost two times less than after applying any other method. Also, with this type of laparotomy according to Joel-Kohen, the likelihood of infectious diseases and the formation of hematomas in the front of the abdomen is halved. This method is also convenient for the doctors themselves, 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 peritoneum, as well as the presence of only two incisions on the sides, one large incision and not affecting the aponeurosis.
• Reducing bleeding due to fewer stitches (almost one and a half times), not affecting the branches of blood vessels and cutting less used muscles.
• A significant amount of time is saved due to the fact that all the muscles and the peritoneum are not cut, but stretched with blunt objects (the edges of straight scissors) and fingers - literally in the second minute the fetus is already taken.
• The simplicity of the whole operation allows not only OB/GYNs, but also other licensed surgeons and trainees to perform it, so that several operations can be performed at the same time if the number of operating rooms in the hospital allows.
• Reduces the risk of injury to organs,placed near the uterus because the peritoneum is stretched by the doctor's fingers rather than cut with a scalpel.
• In the postoperative period, the risk of complications, infectious diseases and hematomas in the peritoneal region is reduced.
• Reduces the risk of infertility in women, as well as failure of hormone production and menstrual cycles.

This type of laparotomy according to Joel-Kohen 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 technique, which is more painful and dangerous after the operation. It has been announced by the UK Association that this technology will soon be used in the training of medical professionals to immediately take up the method that will bring more favorable results.

Suture

In modern medicine, there are several materials used in different 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 suture

This type of medical thread is used in obstetrics after childbirth and caesarean section. She sews up all the incisions, muscles, peritoneum, as well as the aponeurosis. When using the Joel-Cohen method, onlyside cuts made before stretching, as well as the transverse cut itself on the abdomen.

Unfortunately, on the fifth day after stitching all the cuts, inflammation is observed, which lasts about a month. It is noticed that approximately on the twenty-eighth day it passes if the thread contains maxon or polydioxanone, which is in the synthetic absorbable thread.

Also, its advantage is observed in the following:

• 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 apply new stitches. With a synthetic absorbable thread, there is no such problem, as it retains its strength until the cuts are completely healed.
• When using a synthetic absorbable thread, which has only Maxon in its composition, the healing period of cuts passes much faster. Polydioxanone is used when a woman has diseases that were before pregnancy.
• This thread has a low reactogenicity, which is also positive - cuts do not fester during healing, do not diverge and the inflammation goes away much faster.
• The use of a synthetic absorbable thread does not bear any undesirable consequences in the form of infectious diseases, suppuration and failure of hormone secretion.

Other advanced caesarean section methods

There are many caesarean section techniques that certainly have their benefits. After allone action, done not according to a certain technique, already has its result, unlike others. Therefore, every obstetrician-gynecologist who is not afraid to bring his developments into reality can create his own method.

Pfannenstiel laparotomy

This type of operation has its own huge drawback - due to the huge number of incisions, many cesarean stitches are applied, which also threaten to disperse, and heavy bleeding appears, which makes the operation difficult to perform. However, if you already know how to make incisions and remember exactly where they should be, the operation can be carried out quickly, without taking into account the constant bleeding.

Everything is sewn up with several stitches to prevent their opening, however, 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 take analgesics.

Misgav-Ladach Technique

Laparotomy according to Misgav-Ladakh has the advantage over the previous one in less bleeding, surgery time and postoperative complications and pain. Also, when stitching cuts, less sewing material is used, as a result of which the woman is not threatened with festering wounds.

The essence of the method is that after the incision, the abdominal cavity is cut, the muscles are cut with scissors on the sides before that, the placenta is separated in a blunt way, and the uterus is taken out with the fingers. All incisions, as in the Joel-Cohen method, are transverse. This is the advantage of this type of caesarean section over the first one.

Conclusion

As you can see,There are a lot of ways how a caesarean section is performed. This is not just an operation to remove the fetus from the uterus. This is a great opportunity for women to have a painless baby with only a few cuts and stitches on the inside and one on the outside. It is often used when the fetus has been damaged by an external factor, such as a blow to the abdomen or a fall. In addition, caesarean section is an excellent option for an almost painless birth of a child for those women who suffer from an increased pain threshold. But most popular according to Joel-Cohen.

Laparotomy in this way is an improved technique for performing a caesarean section, which has a number of advantages compared to its own kind. This is not a significant blood loss, and the minimum amount of use of threads, a decrease in the possibility of developing infectious diseases and the appearance of hematomas in the peritoneal region, and not the fear of detecting infertility or malfunctions of the hormonal system as a result. The technique is very popular, as it suits almost all women. In addition, after its application, it is possible to give birth to a child again, using a caesarean section.