Double knots versus triple knots facia closure method during cesarean section; is there a difference in pain sensation or cosmetic satisfaction? A randomized controlled trial comparing two different surgical methods in terms of pain and cosmetic satisfaction

Abstract

Background This study aims to compare the effects of two different fascia closure techniques on cosmetic and pain outcomes after a cesarean section. Methods Patients planned for cesarean section were randomized into two groups. In Group I (double knots group), the edge of the fascia was identified with a Kocher clamp. A synthetic absorbable multifilament suture was used to close the fascia in a continuous fashion, starting from the opposite side up to the Kocher clamp. The knots were tied with the same single suture. In Group II (triple knots group), the edge of the fascia was fixed with the same suture material instead of the Kocher clamp. The fascia was closed similarly, starting from the opposite corner via the second loop. The loops from the first suture were tied to the second suture. Postoperative pain at and around the incision line was measured on the 1st, and 10th days postoperatively on the NRS (Numeric Rating Scale). Analgesic medication required during hospitalization was also recorded. Patient satisfaction with the final aesthetic results of the incision was assessed using a 10-point scale at the 1st and 3rd months postoperatively. Results A total of 711 patients were enrolled, of which 218 were randomized to each interventional group (109 patients in each of the two groups). There was no significant difference in pain scores between the groups on the 1st and the 10th postoperative days (p > 0.05). There were significant differences in nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol use between groups during the post-cesarean hospitalization. Regardless of the type of drug, patients in Group I required higher doses of pain medication than those in Group II, with median doses of NSAIDs of 3(0–5) vs. 2(0–4) and median doses of paracetamol of 4(1–7) vs. 2(0–6), respectively (p < 0.001). Group II had significantly higher aesthetic satisfaction scores than Group I in both measurements, with a median score of 9(4–10) vs. 8(2–10) at the end of the first month and 10 (5–10) vs. 9(3–10) at the end of the third month (p = 0.03,0.02, respectively). Conclusion Compared to double knots, fascia closure with the triple knot closure method is statistically associated with a higher aesthetic satisfaction score and less need for painkillers.