The use of O-ring retractors at Caesarean section : A systematic review and meta analysis

Waring, Gareth; Shawer, Sami; Hinshaw, Kim

doi:10.1016/j.ejogrb.2018.06.037

Cited by 8 publications

(9 citation statements)

References 14 publications

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“…In a meta-analysis of randomized trials, O-ring retractors did not reduce complications of cesarean delivery compared with metal retractors. 34…”

Section: Size Of the Abdominal Wall Incisionmentioning

confidence: 99%

FIGO good practice recommendations on surgical techniques to improve safety and reduce complications during cesarean delivery

Nunes,

Nicholson,

Theron

2023

Intl J Gynecology & Obste

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FIGO is actively contributing to the global effort to reduce maternal morbidity, mortality, and disability worldwide. Cesarean delivery rates are increasing globally, without signs of slowing down. Bleeding associated with cesarean delivery has become an important cause of hemorrhage‐related maternal deaths in many low‐ and middle‐income countries. Correct surgical techniques to improve safety and reduce complications of cesarean delivery is of the utmost importance. This article presents FIGO's good practice recommendations for effective surgical techniques to reduce cesarean complications. Evidence‐based information is included where data are available. An expanded WHO Surgical Safety Checklist for maternity cases is suggested. Different incision techniques through the layers of the abdominal wall with appropriate indications are discussed. Hysterotomy through a transverse incision is described, as are indications for low vertical and classical incisions. Important precautions when extracting the fetus are explained. Uterine closure includes a safe method ensuring adequate reapproximation of the upper segment if a vertical incision is made. The paper concludes with the management of two common bleeding problems following delivery of the placenta.

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“…In a meta-analysis of randomized trials, O-ring retractors did not reduce complications of cesarean delivery compared with metal retractors. 34…”

Section: Size Of the Abdominal Wall Incisionmentioning

confidence: 99%

FIGO good practice recommendations on surgical techniques to improve safety and reduce complications during cesarean delivery

Nunes,

Nicholson,

Theron

2023

Intl J Gynecology & Obste

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“…13 The device has been used to provide adequate and atraumatic wound retraction during surgery, together with its ability to reduce postsurgical infections, particularly during gastrointestinal surgeries. 13,14,15,16,17,18,19 The environmental impact of producing the Alexis ® retractors has to be balanced with the benefits derived from its clinical use in the long term.…”

Section: Introductionmentioning

confidence: 99%

“…In comparison with traditional metal retractors, the relatively high cost of the Alexis ® retractors prohibits their routine use currently. 5,6,16 Researchers opined that if Alexis ® retractors show significant SSI reduction during CS, the high cost would be justified considering the overall impact of SSI on the healthcare system and patients. 16 Surgical site infections have been reported to increase the cost of healthcare by nearly $3 -$10 billion because of the number of patients who develop SSI and the resultant high risk of death, which often complicates SSI.…”

Section: Introductionmentioning

confidence: 99%

“…5,6,16 Researchers opined that if Alexis ® retractors show significant SSI reduction during CS, the high cost would be justified considering the overall impact of SSI on the healthcare system and patients. 16 Surgical site infections have been reported to increase the cost of healthcare by nearly $3 -$10 billion because of the number of patients who develop SSI and the resultant high risk of death, which often complicates SSI. Furthermore, on average, most SSI patients spend an extra 7-11 days in hospital, and about 60% of them will eventually end up in the intensive care unit.…”

Section: Introductionmentioning

confidence: 99%

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Alexis O-ring wound retractor versus traditional metal retractors for the prevention of postcaesarean surgical site infections

Mothiba

Tshepuwane²,

Adefolalu³

et al. 2023

S Afr Fam Pract

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Background: Postcaesarean surgical site infections (SSI) remain a burden globally. The Alexis® O C-Section Retractor, a plastic sheath retractor known to have decreased incidence of SSIs in gastrointestinal surgery, is yet to have its efficacy established during caesarean section (CS). This study aimed to compare the differences in the rate of postcaesarean surgical wound site infections between the Alexis® retractor and traditional metal retractors during CS at a large tertiary hospital in Pretoria.Methods: Pregnant women scheduled for elective CS were prospectively randomised to either the Alexis® retractor group or the traditional metal retractor group at a tertiary hospital in Pretoria between August 2015 and July 2016. The defined primary outcome was development of SSI, and secondary outcomes comprised patients’ peri-operative parameters. All participants’ wound sites were observed in the hospital for 3 days before discharge and again at 30 days postpartum. Data were analysed using SPSS version 25 with p 0.05 considered significant.Results: A total of 207 participants were involved, Alexis® (n = 102) and metal retractors (n = 105). None of the participants developed postsurgical site wound infection after 30 days, and there were no differences in time to delivery, total operative time, estimated blood loss or postoperative pain between the two arms of study.Conclusion: The study found no difference in participants’ outcomes using the Alexis® retractor in comparison with the traditional metal wound retractors. We suggest that the use of Alexis® retractor be at the surgeon’s discretion and its routine use not advised for now.Contribution: This research being the first of its kind in South Africa in which patients’ clinical outcomes were compared post caesarean section from Alexis’s plastic sheath group and metal retractors group in an attempt to proffer solution to the high burden of SSI. Although no difference was seen at this point, the research was pragmatic, as it was carried out in a setting with high burden of SSI. The study is going to serve as a baseline against which studies carried out in future can be compared.

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“…For example, studies have examined the effect of antiseptic skin preparation [5,6], perineal hair removal [7], antibiotic prophylaxis [8,9], vaginal irrigation [10], and different skin closure techniques [11]. Studies have also investigated the use of various surgical apparatuses to reduce wound infection rates including O-ring retractors [12], the Lap-Protector [13], and adhesive incisional drapes [14,15]. Adhesive incisional drapes are used in numerous types of surgery including general or abdominal, orthopedic, and cardiac to limit wound infection.…”

Section: Introductionmentioning

confidence: 99%

Adhesive incisional drapes during cesarean delivery for preventing wound infection: A systematic review and meta-analysis of randomized controlled trials

Eckler

Quist‐Nelson

Saccone

et al. 2019

European Journal of Obstetrics & Gynecology and Reproductiv

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ObjectiveTo compare the incidence of wound infection after cesarean delivery in procedures conducted using adhesive incisional drapes verses no adhesive incisional drapes.Study DesignSearches were performed in electronic databases (MEDLINE, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, Scopus, OVID, EMBASE, and the PROSPERO International Prospective Register of Systematic Reviews). We included randomized controlled trials comparing adhesive incisional drapes to no adhesive incisional drapes during cesarean delivery. The primary outcome of this meta-analysis was wound infection. Meta-analysis was performed using the random effects model of DerSimonian and Laird, to produce relative risk (RR) with 95% confidence interval (CI).Results52 publications were identified through initial search of databases and two randomized controlled trials were eligible and included in the meta-analysis. Our meta-analysis examined a total of 1943 subjects and showed a statistically significant increase in wound infections in patients in the adhesive incisional drape group when compared to the control group (RR: 1.29, 95% CI: 1.02–1.65).ConclusionAdhesive incisional drapes may increase the incidence of wound infections after cesarean delivery. Further studies are necessary to explore this relationship in the setting of current postoperative infection prophylaxis, including broad-spectrum antibiotic coverage, skin preparation and vaginal cleansing.

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The use of O-ring retractors at Caesarean section : A systematic review and meta analysis

Cited by 8 publications

References 14 publications

FIGO good practice recommendations on surgical techniques to improve safety and reduce complications during cesarean delivery

FIGO good practice recommendations on surgical techniques to improve safety and reduce complications during cesarean delivery

Alexis O-ring wound retractor versus traditional metal retractors for the prevention of postcaesarean surgical site infections

Adhesive incisional drapes during cesarean delivery for preventing wound infection: A systematic review and meta-analysis of randomized controlled trials

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