الفهرس 
Review of LiteraturOnly 14 pages are availabe for public view
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Abstract
Cesarean section is the most commonly performed surgical procedure in obstetric practice (Natl et al., 2012). Cesarean section is associated with the risk of short term and long-term complications. Short-term complications include injury of bladder, ureter, intestine and deep venous thrombosis. Long-term complications include chronic pelvic pain, infertility, intestinal obstruction, rupture uterus and abnormal placentation in subsequent pregnancies (CORONIS et al., 2013).
Previous studies revealed an association between the technique of uterine incision closure and the poor healing of the cesarean section scar and the occurrence of rupture uterus and abnormal placentation in subsequent pregnancies (Gyamfi et al., 2006).
Cesarean section uterine incision can be closed using the single or double-layer technique with interrupted or continuous (locked or unlocked) sutures, there is no consensus on the best technique for uterine incision closure at cesarean section. Several studies reported that the single layer closure and locked continuous suturing of the uterine incision are associated with a higher risk of uterine rupture in subsequent pregnancies compared with double layer closure (Ceci et al., 2012).
On the other hand, other studies revealed that single layer closure or locked suturing is not associated with increased risk of rupture (Yasmin et al., 2011).
A recent meta-analysis revealed that locked singled layer closure of uterine incision is associated with a five-fold increase in the risk of uterine rupture compared with double layer closure. On the other hand, unlocked singled layer closure of uterine incision is not associated with increased risk of uterine rupture compared with double layer closure (Roberge et al., 2011).
There is scarcity in the literature that compared the risk of uterine rupture after uterine incision closure with interrupted or continuous sutures. It was reported that the cesarean section scar defect was Larger after single layer closure of uterine incision with continuous locked suture compared with single layer closure of uterine incision with interrupted sutures (Ceci et al., 2012).
The authors suggested that continuous sutures might impair the blood supply of the uterine tissues and induce more foreign body reaction and therefore interfere with proper healing of cesarean section scar.
Barbed suture is a relatively new class of sutures. Unlike conventional smooth suture, barbed suture has barbs on its external surface. These barbs resist backward movement of the suture thread and anchor tissues without the need for knots tying at both ends of suture thread (Fouda et al., 2016).
In plastic surgery, the use of a barbed suture to repair soft tissues reduces the operative time with equal cosmesis scores and wound complication rates. In laparoscopic surgery, barbed suture facilitates suturing and significantly reduces suturing and operative times (Fouda et al., 2016).
The study is aimed to compare the uterine closure time and blood loss during closure of uterine incision at cesarean section.
This study was conducted at Ain Shams University Maternity Hospital in a period of July 2019 and March 2020. It is a randomized controlled clinical trial, the study included 90 patients who underwent lower segment cesarean section divided into two groups. The first group 45 patients in which the uterine incision was closed by two layers of continuous barbed sutures (stratafix) and the second group 45 patients in which the uterine incision was closed by two layers of continuous conventional smooth sutures (Vicryl).
The main results of the study revealed that:
1. There was no statistically significant difference in the mean age in both groups (28.7±5.8 versus 31.3±4.0, p= 0.017).
2. There was no statistically significant difference in the mean gravidity in both groups (2.64±1.28 versus 2.58±0.8, p= 0.77).
3. There was no statistically significant difference in the mean parity in both groups (p= 0.76).
4. There was no statistically significant difference in the mean BMI in both groups (26.9±2.04 versus 27.3±1.4, p=0.34).
5. There was no statistically significant difference in the mean initial hematocrit (Hi) in both groups (34.8±3.5 versus 35±3.5, p=0.71).
6. There was highly statistically significant difference in the mean total operative time (min) in both groups (37±4.1 versus 42±3.7, p=0.0001).
7. There was highly statistically significant difference in the mean uterine closure time (min) in both groups (4.1±0.6 versus 8.6±1.2, p=0.0001).
8. There was highly statistically significant difference in the mean number of used towels in both groups (p=0.0001).
9. There was highly statistically significant difference in the mean of need of additional hemostatic sutures in both groups (p=0.0001).
10. There was highly statistically significant difference in the mean allowable blood loss in both groups (605±66 versus 671±92, p=0.0001).
11. There was no statistically significant difference in the mean final hematocrit (Hf) in both groups (30.5±3.1 versus 30.96±3.2, p=0.5).
12. There was no statistically significant difference in needing for blood transfusion or postoperative fever (100% in each group).
13. There was highly statistically significant difference in the mean cost of suture (22.75±0 $ versus 11.025 ±1.61 $, p=0.001).
Based on these results of this study further studies was recommended to investigate the association between the type of suture (barbed or smooth) and long term complications of cesarean section.