The Effect of Fascia Closure with Smead-Jones Technique on Postoperative Pain During Cesarean Section

Introduction: The severity of pain in the postoperative period significantly increases morbidity and it is very important to provide adequate analgesia and prevent severe pain in the postpartum period, which requires patients to return to their daily lives earlier. In classical cesarean section (CS) incision repair, the fascia is closed with continuous sutures. In 1941, the Smead-Jones technique described by Jones was shown to be superior to other techniques in terms of incisional separation, wound infection, postoperative lung infection and abdominal distension. Material and method: The study was planned as an observational prospective study. Patients who were admitted to the obstetrics and gynecology service between February 2023 and July 2023 and scheduled for cesarean section were included in the study after information was given and consent was obtained. Patients who were operated under general anesthesia and had BMI>30, 4 or more cesarean sections, and those who did not give consent were excluded from the study. Patients who used routine continious suture and Smead Jones technique during fascia closure were randomly divided into two groups. Patients were evaluated at the 1st hour postoperatively, at the 6th hour after mobilization and at the 24th hour postoperatively by recording the visual pain scale. Age, body mass index, chronic disease status, smoking, gestational week, indication for cesarean section, history of previous operation, number of gravida-parity, infant weight, weight gained during pregnancy and breastfeeding status were recorded. Results: A total of 147 patients who met the inclusion and exclusion criteria within the specified time interval were included in the study. In the Smead Jones group of 75 patients, mean age was 29.09±4.7 years, mean height 161.11±4.8, mean weight 78±13.4, mean gestational age 37±1.42, mean weight gained during pregnancy 12.19±4.50, and mean baby weight 3041±350 g. There were 72 patients who met the inclusion and exclusion criteria in the continuous suture group, which was our classical closure technique, which was taken as a control group. The mean age of the patients in the control group was 27.64±5.02 years, mean height 160.8±5.53, mean weight 74.82±13.76, mean gestational age 38±1.75, mean weight gained during pregnancy 13.68±6.42, and mean baby weight 3153±371 g. . In terms of total number of cesarean sections, the number of cesarean sections in the study (Smead Jones) group was significantly higher (p<0.05). When evaluated according to visual pain scoring, although there was no significant difference at the 1st hour, the value of the Smead Jones group was statistically significantly lower at the 6th and 24th hours (p<0.01). In terms of mean cesarean section times, there was a difference of approximately 2 minutes between Smead Jones closure and continiu closure and this value was not significant. Conclusion: Despite advances in surgery, improvements in anesthesia, increased drug options, and increased knowledge about preoperative and postoperative care, serious complications related to wound healing still occur after major abdominal operations. Although there are no studies in the literature on cesarean section using the Smead Jones technique, this study is a first. Considering the suture size in operations other than cesarean section, the Smead Jones technique has advantages over traditional methods. The fact that there is no significant difference in case duration, less postoperative pain and complications may be a factor in the preference of the Smead Jones technique.