Comparison of the Joel-Cohen-based technique and the transverse Pfannenstiel for caesarean section for safety and effectiveness: A systematic review and meta-analysis

Abstract

Background: Caesarean section (C-section) is the most common surgery among women worldwide, and the global rate of this surgical procedure has been continuously rising. Hence, it is significantly crucial to develop and apply highly effective and safe caesarean section techniques. In this review study, we aimed at assessing the safety and effectiveness of the Joel-Cohen-based technique and comparing the results with the transverse Pfannenstiel incision for C-section. Methods: In this study, various reliable databases such as the PubMed Central, COCHRANE, DARE, and Ovid MEDLINE were targeted. Reviews, systematic reviews, and randomized clinical trial studies comparing the Joel-Cohen-based technique and the transverse Pfannenstiel incision were selected based on the inclusion criteria. Selected studies were checked by 2 independent reviewers based on the inclusion criteria, and the quality of these studies was assessed. Then, their data were extracted and analyzed. Results: Five randomized clinical trial studies met the inclusion criteria. According to the exiting evidence, statistical results of the Joel-Cohen-based technique showed that this technique is more effective compared to the transverse Pfannenstiel incision. Metaanalysis results of the 3 outcomes were as follow: operation time (5 trials, 764 women; WMD -9.78; 95% CI:-14.49-5.07 minutes, p<0.001), blood loss (3 trials, 309 women; WMD -53.23ml; 95% –CI: 90.20-16.26 ml, p= 0.004), and post-operative hospital stay (3 trials, 453 women; WMD -.69 day; 95% CI: 1.4-0.03 day, p<0.001). Statistical results revealed a significant difference between the 2 techniques. Conclusion: According to the literature, despite having a number of side effects, the Joel-Cohen-based technique is generally more effective than the Pfannenstiel incision technique. In addition, it was recommended that the Joel-Cohen-based technique be used as a replacement for the Pfannenstiel incision technique according to the surgeons’ preferences and the patients’ conditions.

Misgav‐Ladach or modified Misgav‐Ladach versus Pfannenstiel‐Kerr methods for cesarean deliveries: A systematic review and meta‐analysis

“…Previous meta-analyses have grouped all Joel-Cohen based methods (Joel-Cohen method, MLM, and MMLM) within one cohort, therefore limiting conclusions with the inability to separate the methods. 45,46 The findings of this meta-analysis provide evidence to demonstrate favorability of the MLM and MMLM techniques over PKM.…”

“…This meta‐analysis is the first to separate MLM and MMLM in their comparison to PKM, with findings of MLM and MMLM to be favourable over PKM in operative time, blood loss, and length of hospital stay. Previous meta‐analyses have grouped all Joel‐Cohen based methods (Joel‐Cohen method, MLM, and MMLM) within one cohort, therefore limiting conclusions with the inability to separate the methods 45,46 . The findings of this meta‐analysis provide evidence to demonstrate favorability of the MLM and MMLM techniques over PKM.…”

Risk, Prevention and Management of Complications After Vaginal and Caesarean Section Birth

“…Caesarean section is the most common surgery among women worldwide, with the global rate rising. 34 In a recent meta-analysis, Sobhy et al 35 reported the risk of maternal death after caesarean section at 7.6 per 1000 procedures (95% CI 6.6-8.6) with the highest burden in sub-Saharan Africa. In LMICs, one in every 100 women dies after caesarean section whereas in high-income countries, there are eight maternal deaths per 100,000 caesarean sections.…”