首次剖宫产单层缝合法与双层缝合法有效性与安全性的Meta分析

目的:评估首次剖宫产单层缝合法与双层缝合法的有效性与安全性。方法:检索CENTRAL、Pub Med、SCIE、Embase、CNKI、VIP、万方等数据库,检索时限为2005~2016年,收集首次剖宫产单层缝合法与双层缝合法有效性与安全性的相关文献。采用Revman5.2软件进行Meta分析。结果:纳入文献15篇,共有10929例剖宫产手术,其中6778例剖宫产采用的是单层缝合法,4151例采用的是双层缝合法。Meta分析结果显示:与首次剖宫产单层缝合法相比较,双层缝合法手术时间较长(Z=2.46,MD-4.01,95%CI-7.22~-0.81,P=0.01),术中出血量多(Z=85.49,MD 69.97,95%CI 68.36~71.57,P0.00001),术后月经不调发生率低(Z=3.52,OR 2.41,95%CI 1.48~3.93,P=0.0004),瘢痕憩室发生率低(Z=2.20,OR 1.5,95%CI 1.05~2.15,P=0.03),子宫切口愈合不良发生率较低(Z=3.03,OR 2.62,95%CI 1.40~4.88,P=0.002),产后出血发生率(Z=1.27,OR 1.54,95%CI 0.79~2.98,P=0.20)及再次妊娠先兆子宫破裂或子宫破裂(Z=1.63,OR 2.02,95%CI0.87~4.72,P=0.10)差异无统计学意义。结论:对于剖宫产不同缝合方式而言,双层缝合法增加了手术时间及术中出血量,但可降低术后月经不调、切口愈合不良及瘢痕憩室发生率,由于本Meta分析纳入文献基本为回顾性研究,且文献质量不高,可能对结论的真实性有一定影响,建议临床妇产科医师谨慎选择。     

二次剖宫产行子宫瘢痕切除术预防剖宫产切口瘢痕憩室效果的临床研究

目的:比较二次剖宫产术中原子宫切口瘢痕切除与否对剖宫产切口瘢痕憩室(PCSD)形成的影响,为临床PCSD的预防提供依据。方法:选取择期二次剖宫产的产妇共360例,其中采用先行原子宫切口瘢痕切除,再双层连续缝合子宫的产妇为研究组,直接行双层连续缝合子宫的产妇为对照组。统计两组手术时间、术中出血量、术后血性恶露持续时间、肛门排气时间、住院天数。术后6月至1年进行随访,评估是否出现异常阴道流血,并在术后1年应用阴道三维超声评估子宫切口愈合情况,分别统计两组产妇形成PCSD的例数,憩室残余子宫肌层厚度及憩室的大小。结果:两组的手术时间、术中出血量、术后血性恶露持续时间、肛门排气时间、住院天数差异均无统计学意义(P0.05);研究组与对照组形成PCSD的例数分别为4例(2.2%)、15例(8.3%);憩室残余子宫肌层厚度均值分别为7.35±1.89 mm、4.98±2.03 mm;憩室容积分别为0.36±0.17 ml、0.53±0.13 ml(P0.01)。结论:二次剖宫产术中切除原子宫切口瘢痕更利于切口愈合,减少PCSD的形成,减轻所形成的PCSD的程度。     

机器人辅助腹腔镜手术与传统开腹手术治疗子宫内膜癌效果对比的Meta分析

目的:应用Meta分析对比机器人辅助腹腔镜手术(RS)与传统开腹手术(OS)在治疗子宫内膜癌的效果及安全性,进而指导临床的治疗。方法:计算机检索Pub Med,Medline,Cochrane Library Databases and Embase数据库,检索时间从建库到2017年4月止。收集期间公开发表的关于RS与OS在治疗子宫内膜癌疗效对比的文献,由两位研究员独立依照纳入和排除标准筛选文献、提取数据和进行文献质量评估后,利用Review Manager 5.3统计软件进行Meta分析。结果:共纳入27篇文献,涉及4440例患者,其中RS 1973例,OS 2467例。Meta分析结果显示RS与OS相比,术中出血量少(MD=-168.19,95%CI-190.51~-145.87,P0.00001)、术后住院时间短(MD=-3.05,95%CI-3.43~-2.68,P0.00001)、术中输血率低(OR=0.24,95%CI 0.16~0.36,P0.00001)、术中并发症发生率低(OR=0.60,95%CI 0.39~0.94,P=0.02)、术后并发症发生率低(OR=0.39,95%CI0.25~0.60,P0.0001)、总并发症发生率低(OR=0.28,95%CI 0.21~0.37,P0.00001),再入院率低(OR=0.41,95%CI 0.27~0.64,P0.0001),总生存率高(OR=2.15,95%CI 1.11~4.18,P=0.02),但手术时间延长(MD=40.72,95%CI 8.37~72.71,P=0.01)。盆腔淋巴结切除数目(MD=-1.13,95%CI-2.98~0.27,P=0.23)、腹主动脉淋巴结切除数目(MD=-0.28,95%CI-2.64~2.08,P=0.82)、总淋巴结切除数目(MD=0.43,95%CI-2.32~3.18,P=0.76)、无疾病生存率(MD=1.69,95%CI 0.68~4.21,P=0.26)无明显差异。结论:在子宫内膜癌的治疗中,RS比OS损伤小,患者恢复快,安全性和有效性更高。     

剖宫产术子宫切口单层缝合法

剖宫产术子宫切口单层缝合法杨瑞兰，俞建礼，谢桂兰，田成芹子宫下段剖宫产术子宫下段切口的缝合通常用双层缝合法。有文献报道，剖宫产术后子宫切口裂开率为０．４０％～１．２６％￣［１］。我们考虑子宫切口愈合不良可能与缝合层次有关。我院自１９８８年始改用子宫下...     

宫腹腔镜联合手术与经阴式手术比较治疗剖宫产切口憩室的Meta分析

目的:评价宫腹腔镜联合手术与经阴式手术治疗子宫切口憩室的效果。方法:检索the Cochrane Central Register of Controlled Trials(CENTRAL)、Pub Med、SCIE、EMbase、CNKI、VIP、万方数据库等数据库,查找宫腹腔镜联合手术与经阴式手术治疗子宫切口憩室的随机对照试验(RCT)相关文献,同时手检纳入文献的参考文献。按纳入排除标准由2名评价员独立进行RCT的筛选、资料提取和质量评估后,采用Rev Man5.1软件进行Meta分析。结果:纳入文献14篇,共884例患者,其中481例行宫腹腔镜联合手术或宫腔镜电切手术或开腹手术(观察组),403例仅行经阴式手术(对照组)。Meta分析显示,与经阴式手术比较,宫腹腔镜联合手术患者的手术时间较长(MD=13.99,95%CI为4.76~23.23,P=0.003),术中出血少(MD=-13.08,95%CI为-22.98~-3.18,P=0.01),住院时间短(MD=-2.10,95%CI为-3.45~-0.75,P=0.002),治疗费用多(SMD=6.93,95%CI为4.50~9.35,P0.00001),术后总并发症发生率低(RR=0.38,95%CI为0.19~0.75,P=0.006),术后阴道出血时间短(MD=-3.16,95%CI为-5.26~-1.05,P=0.003),术后肛门排气时间差异无统计学意义(MD=0.26,95%CI为-0.22~0.75,P=0.29),术后月经恢复情况好(OR=1.89,95%CI为1.11~3.20,P=0.02),术后憩室修复情况好(OR=2.16,95%CI为1.20~3.88,P=0.010)。结论:宫腹腔镜联合手术与经阴式手术治疗子宫切口憩室比较,手术时间较长,治疗费用高,术后肛门排气时间无明显差异,但住院时间短,术后阴道出血时间短,术中出血少,安全性更高;可提高月经恢复情况、憩室修复情况。但原始研究质量均较低,建议临床上审慎选择使用;需更多高质量、大样本研究进一步验证。     

剖宫产子宫瘢痕缺损的影响因素

剖宫产瘢痕缺损(caesarean scar defects,CSD)表现为超声下子宫下段低回声区,是子宫肌层在前次剖宫产切口处发生缺如或断裂,影响约30%的剖宫产女性。目前关于形成CSD的直接原因尚不明确,研究发现术中切口位置过低、单层缝合、使用铬制肠线、患者心理压力大、子宫后位和多次剖宫产等均为形成CSD的危险因素;双层缝合、腹膜缝合、使用可吸收缝线等更利于切口的愈合;另外,CSD的形成还与长期使用皮质类固醇药物、子宫腺肌病和子痫前期病史等多种因素有关。     

腹腔镜下子宫内膜癌分期手术疗效及安全性的Meta分析

目的系统评价腹腔镜手术在子宫内膜癌治疗中的疗效及安全性。方法以"子宫内膜癌"、"腹腔镜"等关键词检索2004年1月至2015年1月的Pubmed数据库,重庆维普中文科技期刊数据库,万方数据库,中国知网全文期刊数据库。依据Cochrane系统评价方法,应用系统评价专用软件RevMan 5.2软件对所提取的数据进行Meta分析。结果共纳入7篇符合要求的随机对照试验文献,Jadad量表评分均≥3分。共计379例患者,其中腹腔镜下筋膜外子宫+双附件+盆腔、腹主动脉旁淋巴切除术178例(腹腔镜组),开腹筋膜外子宫+双附件+盆腔、腹主动脉旁淋巴术201例(开腹组)。Meta分析显示:在子宫内膜癌治疗中,与开腹组比较,腹腔镜组术中出血量少[均数差(MD)=-236.27,95%可信区间(CI):-461.79~-10.75,P0.00001];住院时间短(MD=-5.33,95%CI:-7.82~-2.85,P0.05);肛门排气时间短(MD=-24.10,95%CI:-33.5~14.69,P0.05);其中手术时间(MD=0.08,95%CI:-37.55~37.70)、淋巴结切除数(MD=-1.95,95%CI:5.25~1.34)、术后15个月复发率(OR=0.85,95%CI:0.24~3.09)、术后40个月总生存率(OR=1.08,95%CI:0.21~5.59)比较,差异均无统计学意义(P0.05)。结论在治疗子宫内膜癌中,腹腔镜手术具有可靠的安全性且值得推广,但因随访时间较短,无法在复发率及总生存率方面体现其优势。     

经阴道手术治疗剖宫产瘢痕憩室的预后影响因素分析

目的:探讨经阴道手术治疗剖宫产瘢痕憩室(CSD)的疗效及其预后影响因素。方法:回顾性分析2016年9月至2018年4月在南京医科大学附属妇产医院经阴道手术治疗的55例CSD患者的临床资料,随访术后恢复情况并比较影响手术疗效的因素。结果:①术后3个月B超检测憩室完全消失率为74.55%(41/55),术后6个月78.18%(43/55)的患者月经期缩短至10天以内。②子宫前位或中位的患者术后愈合良好(术后经期≤10天)率(87.88%)高于子宫后位的患者(63.64%)(χ~2=4.548,P=0.033);愈合良好组的术前憩室深度(8.28±1.42 mm)小于愈合不良组患者的术前憩室深度(9.58±2.61 mm),差异有统计学意义(t=-2.302,P=0.025);愈合良好组的残余肌层厚度(3.31±1.22 mm)大于愈合不良组(2.42±0.85 mm),差异有统计学意义(t=2.384,P=0.021)。③多因素分析结果示子宫位置、术前憩室深度和残余肌层厚度是影响手术疗效的独立因素(P0.05)。结论:经阴道手术治疗CSD能够改善患者症状,子宫后位、憩室深度及残余肌层厚度是手术修复效果的独立影响因素。     

新式剖宫产术的改良及临床应用

目的 探讨改良式剖宫产术的临床价值。方法 于耻骨联合上2．5～3cm沿半月形腹壁横沟做横弧形切口，钝性分离脂肪层及筋膜，将腹直肌与筋膜游离开，钝性撕开腹直肌与腹膜，取子宫下段高位切口，可吸收线单层连续锁扣缝合子宫肌层，不缝合腹膜，可吸收线缝合腹直肌前鞘，4号丝线将皮下脂肪及皮肤缝合3针。与传统式剖宫产术、新式剖宫产术的各项指标进行比较。结果 在切皮到胎儿娩出时间、手术时间、出血量和住院天数方面，各组间差异有显著性，其中改良式剖宫产术在以上各项中所用时间最短，出血量最少（P〈0．05或P〈0．01），其后依次是新式剖宫产术和传统式剖宫产术；术后排气时间、坐起喂奶时间，改良式剖官产术与新式剖宫产术差异无显著性，但两者均优于传统式剖宫产术（P〈0．05）。结论 改良式剖宫产术操作简单，优点明显，值得临床推广。     

二次剖宫产术中切除原子宫切口瘢痕组织对子宫瘢痕憩室形成的预防作用观察

目的观察二次剖宫产术中切除原子宫切口瘢痕组织对子宫瘢痕憩室(PCSD)形成的预防作用。方法选取2016年5月至2018年6月皖北煤电集团总医院188例择期二次剖宫产产妇,采用随机数字表法分为观察组与对照组,各94例。对照组术毕子宫切口直接予以双层连续缝合,观察组术毕先切除原子宫切口瘢痕组织,再行双层连续缝合,随访2年,比较两组术中及术后指标以及2年内异常阴道流血及子宫瘢痕憩室形成情况。结果两组术中及术后指标比较,差异均无统计学意义(P0.05);观察组术后2年内异常阴道流血发生率(3.19%vs 11.70%)、PCSD发生率(2.13%vs 9.57%)低于对照组(P 0.05),瘢痕憩室残余子宫肌层厚度大于对照组,瘢痕憩室容积小于对照组(P 0.05)。结论二次剖宫产术中切除原子宫切口瘢痕组织可预防PCSD的形成并减轻其形成的严重程度。     

Hydrosonographic assessment of the effects of 2 different suturing techniques on healing of the uterine scar after cesarean delivery

Objective

To compare the effects of 2 suturing techniques (single versus double layer) on healing of the uterine scar after a cesarean delivery.

Methods

In the present randomized, prospective study, 36 women with a term pregnancy who had an elective cesarean delivery were randomly assigned to closure of the uterine incision with a single-layer locked suture or with a double-layer locked/unlocked suture. Six months after the operation, the integrity of the cesarean scar at the uterine incision site was assessed by hydrosonography. The healing ratio and the thickness of the residual myometrium covering the defect were calculated as markers of uterine scar healing.

Results

There were no significant differences between the groups in terms of estimated blood loss, operation time, or additional hemostatic suture. However, the mean thickness of the residual myometrium covering the defect was 9.95 ± 1.94 mm after a double-layer closure and 7.53 ± 2.54 mm after a single-layer closure (P = 0.005). The mean healing ratio was significantly higher after a double-layer closure (0.83 ± 0.10) than after a single-layer closure (0.67 ± 0.15; P = 0.004).

Conclusion

A double-layer locked/unlocked closure of the uterine incision at cesarean delivery decreases the risk of poor uterine scar healing.     

Transverse uterine incision non-closure versus closure: an experimental study in dogs

This study was conducted to test the hypothesis that non-closure of all layers of the uterus during low transverse cesarean section is not associated with increased intra-operative or immediate and late postoperative complication. Eleven pregnant dogs underwent cesarean section for the evaluation of non-closure and closure of all layers of the uterus on immediate or early and late postoperative complication and the effect of suture in tissue. Statistical analysis was performed using Student's t-test for continuous variables and analysis for qualitative variables. Significance was defined as P < 0.05. The ranges of wound infection, other morbidity, and mortality were similar between the groups. The average operating time was significantly less for the non-closure group (71.00+/-7.11 min) than for the closure group (92.00+/-6.12 min; P < 0.005). Adhesion was significantly less (P < 0.001) for the non-closure group than for the closure group. The ranges of myometrial necrosis (5/5: 100% versus 0/5: 00%; P < 0.001) and fibrosis (2/5: 40% versus 0/5: 00%; P < 0.01) were significantly higher for the closure group than for the open group. It was found that non-closure of all layers of the uterus at low transverse cesarean incision had no adverse effect on immediate and late postoperative complication in dogs. Our data show that non-closure of all layers of the uterus at low transverse cesarean incision results in significantly less muscular necrosis and fibrosis than in the closure group. We suggest that non-closure and/or at least non-vigorous locking but very simple closure of all layers of the uterus at low transverse cesarean incision may be preferential in appropriate cases.     

Single- versus double-layer uterine incision closure and uterine rupture.

OBJECTIVE: To evaluate whether closure of the uterine incision with one or two layers changes uterine rupture or vaginal birth after cesarean section (VBAC) success rates. METHODS: Subjects with one previous cesarean section by documented transverse uterine incision that attempted VBAC were identified. Exclusion criteria included lack of documentation of the type of closure of the previous uterine incision, multiple gestation, more than one previous cesarean section, and previous scar other than low transverse.Uterine rupture and VBAC success rates were compared between those with single-layer and double-layer uterine closure. Time interval between deliveries, birth weight, body mass index (BMI), and history of previous VBAC were evaluated as possible confounders. RESULTS: Of 948 subjects identified, 913 had double-layer closure and 35 had single-layer closure. The uterine rupture rate was significantly higher in the single-layer closure group (8.6% vs. 1.3%, p = 0.015). This finding persisted when controlling for previous VBAC, induction, birth weight >4000 g, delivery interval >19 months, and BMI >29 (OR 8.01, 95% CI 1.96-32.79). There was no difference in VBAC success rate (74.3% vs. 77%, p = 0.685). CONCLUSION: Single-layer uterine closure may be more likely to result in uterine rupture.     

Methods for myometrium closure and other factors impacting effects on cesarean section scars of the uterine segment detected by the ultrasonography

OBJECTIVE: Ultrasound examination is an objective method for assessment of uterine scar defects. The present study was conducted to compare single-layer interrupted sutures (Group A) with double-layer interrupted sutures (Group B) and our new method (Group C) as well as other perioperative parameters in relation to risk of wedge defects in scars. METHODS: We have introduced a new myometrium closure procedure consisting of continuous suture with decidual closure followed by interrupted myometrium suture. In this prospective study, women undergoing cesarean operation (n = 137) were examined by transvaginal ultrasound one month after surgery to assess the appearance of lower uterine scars. Multivariate logistic regression analysis was performed to identify associations of perioperative parameters and methods for lower myometrium closure with abnormal wedge formation. RESULTS: Wedge defects were observed in a total of 27 patients (19.7%). The analysis revealed Groups B and C to have reduced risks with odds ratios of 0.28 and 0.077, respectively, as compared to Group A. Furthermore, increasing gestational week at delivery, plural fetal pregnancies, premature rupture of membranes and pre-eclampsia were also linked with an increased risk, with odds ratios of 1.4-8.9. CONCLUSION: The incidence of uterine scar defects 1 month after cesarean sections varies with the method applied for myometrial suture and perioperative variables. The data suggest that methods for myometrium closure as well as other factors influence the condition of myometrial healing.     

Augmenting myometrial healing after cesarean delivery: use of an adjuvant biologic graft placement in an ovine model

We sought to reduce long-term complications after cesarean delivery by improving myometrial healing. Eight sheep (three with twins) underwent cesarean delivery. Hysterotomy sites were repaired in equal parts by suture alone or suture with a juxtaposed graft (Cook Medical, Bloomington, IN). At 90 days postsurgery, scar characteristics and tensile strength testing were assessed. The mean hysterotomy closure time was on average 1 minute, 14 seconds longer for those undergoing graft placement ( P=0.36). The mean scar thickness was 3.0?±?0.4 mm for controls versus 3.8?±?1.2 mm for the intervention group ( P=0.047). Tensile strength testing did not demonstrate a significant difference between groups. Histological examination of the myometrial scar showed no significant differences in inflammatory reaction or endometrial inclusions; however, neoangiogenesis was significantly enhanced. Myometrial repair incorporating a graft increased scar thickness and neoangiogenesis. This methodology did not incite adenomyosis or enhance inflammation within the scar.     

自由体位分娩对母婴分娩结局影响的Meta分析

目的:系统评价初产妇在产程中实施自由体位分娩对母婴结局的影响。方法:计算机检索Pub Med、Embase、CENTRAL、Web of Science、CINAHL、CBM、CNKI、VIP、Wan Fang Data数据库中有关自由体位分娩的随机对照试验,检索时间均为建库至2017年4月4日。由2名研究者独立按纳入、排除标准筛选文献、提取资料、评价纳入研究的偏倚风险后,采用Rev Man 5.3软件进行Meta分析。结果:共纳入18项随机对照试验,3 603例患者。Meta分析结果显示:自由体位分娩与常规卧位分娩在总产程时间(MD=-2.98,95%CI:-3.29^-2.68,P<0.000 01)、剖宫产率(RR=0.43,95%CI:0.37~0.51,P<0.000 01)、自然分娩率(RR=1.33,95%CI:1.27~1.39,P<0.000 01)、产后出血发生率(RR=0.25,95%CI:0.15~0.40,P<0.000 01)、会阴Ⅲ度裂伤发生率(RR=0.33,95%CI:0.17~0.67,P=0.002)、宫颈裂伤发生率(RR=0.34,95%CI:0.21~0.55,P<0.000 01)、新生儿窒息率(RR=0.31,95%CI:0.21~0.47,P<0.000 01)、新生儿颅内出血发生率(RR=0.22,95%CI:0.08~0.57,P=0.002)比较,差异有统计学意义;新生儿吸入综合征发生率(RR=0.73,95%CI:0.30~1.80,P=0.50)比较差异无统计学意义。结论:与常规卧位分娩相比,初产妇产程中采用自由体位分娩可缩短总产程时间,提高自然分娩率,降低剖宫产率,减少产后出血、软产道损伤,降低新生儿窒息和颅内出血的发生率,并且不会增加新生儿吸入综合征的风险。但受纳入研究质量限制,上述结论尚需开展更多高质量研究予以验证。     

Single- versus double-layer uterine incision closure and uterine rupture

Objective. To evaluate whether closure of the uterine incision with one or two layers changes uterine rupture or vaginal birth after cesarean section (VBAC) success rates.

Methods. Subjects with one previous cesarean section by documented transverse uterine incision that attempted VBAC were identified. Exclusion criteria included lack of documentation of the type of closure of the previous uterine incision, multiple gestation, more than one previous cesarean section, and previous scar other than low transverse.

Uterine rupture and VBAC success rates were compared between those with single-layer and double-layer uterine closure. Time interval between deliveries, birth weight, body mass index (BMI), and history of previous VBAC were evaluated as possible confounders.

Results. Of 948 subjects identified, 913 had double-layer closure and 35 had single-layer closure. The uterine rupture rate was significantly higher in the single-layer closure group (8.6% vs. 1.3%, p = 0.015). This finding persisted when controlling for previous VBAC, induction, birth weight >4000 g, delivery interval >19 months, and BMI >29 (OR 8.01, 95% CI 1.96–32.79). There was no difference in VBAC success rate (74.3% vs. 77%, p = 0.685).

Conclusion. Single-layer uterine closure may be more likely to result in uterine rupture.     

Transverse uterine incision non-closure versus closure: an experimental study in sheep

SUBJECT: This study was designed to investigate whether the non-closure of the layers of the uterus during low transverse cesarean section would result in healing and have advantage on closure. MATERIAL AND METHOD: Thirty pregnant ewes randomly divided into two groups. Each group included 15 ewes. Each ewe was anesthetized at para-vertebral region with the injection of 20 ml Prilocine 2%. Following left transverse abdominal incision, a transverse incision was made on the uterus and lambs were delivered. In the first group, uterine incision line was left open. In the second group, uterine incision line was sutured with no. 1 Chromic catgut by Schimiden technique. In both groups, all layers of abdominal wall except skin were sutured as en-bloc with Vicryl no. 2, by continuous suture technique. Skin was sutured with no. 00 silk interrupted sutures. The ewes were slaughtered four months after cesarean section. A coworker was asked to open the abdominal cavities, and score the intra-abdominal adhesions. Tissues taken from incision line of each uterus were fixed in 10% neutral buffered-formalin and were embedded in paraffin-block. Sections were cut and stained with hematoxylin-eosin. A pathologist, who knew nothing about the study, evaluated all sections, and reported the findings. Student's t test was used for comparison of mean ewe age, gestational age, and mean operation time of the two groups. Z test was used for comparing the ratio of the two groups by means of histopathological findings. RESULTS: No cervical dilatation and delivery of the placenta were seen during the four week follow up period. The average operating time was significantly less for the non-closure group (48.07 +/- 3.83 minutes) than for the closure group (62.53 +/- 6.57 minutes; p = 0.001). The ranges of myometrial necrosis (100% versus 13.3%; p = 0.001) and endometriosis (53.3% versus 00.0%; p = 0.001) were significantly higher for closure group than for non-closure group. CONCLUSION: It was found that non-closure layers of the uterus along low transverse cesarean incision proves to have no adverse effect on immediate and late postoperative period in ewes. Our data showed that non-closure of all layers of the uterus results in significantly less muscular necrosis and endometriosis than closure group. We suggest that lower uterine incision can be left unclosed or, at least, simple closure can be preferable instead of vigorous locking technique.