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

The Effect of Fascia Closure with Smead-Jones Technique on Postoperative Pain During Cesarean Section | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Effect of Fascia Closure with Smead-Jones Technique on Postoperative Pain During Cesarean Section betül Kalkan, okay alptekin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5883276/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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. cesarean section Smead Jones postoperative pain Figures Figure 1 Key Points Question: What is the effect of fascia closure with the Smead Jones method on postoperative pain? Findings: This study is a prospective clinical trial with 147 patients divided into 2 groups, which has not been done before in the literature. The study concluded that the need for postoperative analgesics was statistically significant and less in the Smead Jones group. Meaning: Smead Jones technique may be used by obstetricians as it reduces postoperative pain and complications. INTRODUCTION Cesarean section is one of the most common abdominal surgeries for women. According to the World Health Organization (WHO), 1 in 5 births is by caesarean section, and this rate is expected to reach 29% by 2030 1 . Pain control after an operation with such a high frequency is very valuable for both the patient and the baby. Postoperative pain plays an important role in patients' surgical experience. Patients are concerned and fearful about postoperative pain in the preoperative period 2 . Inadequate pain control leads to increased sympathetic nervous system stimulation. Increased pain leads to blood pressure spikes in postoperative hypertensive patients, potentially increasing the risk of cerebral hemorrhage and stroke 3 . The risk of atelectasis and pneumonia decreases with good postoperative pain control, adequate ventilation, coughing and breathing exercises, and the risk of postoperative thrombophlebitis and embolism decreases with increased mobilization of the patient 4 . Postoperative pain is very important in terms of maternal and infant health, adequate contact and bonding, adequate nutrition of the baby and the recovery period of the mother. Chronic postoperative pain may affect the patient's daily activities and may cause deterioration in quality of life. Cesarean section is a common procedure and studies have shown that pain may persist up to 12 months postoperatively 5 . In terms of surgical procedures, there are vertical, oblique and transverse incisions for examining intra-abdominal pathologies. Incisions used in gynecologic surgery can be further divided into transverse and vertical incisions. Most of the incisions used for female genital organs are transverse incisions, which are preferred because they are stronger, less painful, have less risk of dehiscence and have better cosmetic results compared to midline incisions 6 . Since fascia repair in the postoperative incision is valuable for pain control, the choice of the suture technique to be applied is important. In addition to pain control, determination of the suture method that will minimize postoperative complications will increase patient comfort, shorten the duration of hospitalization and reduce the cost of treatment. Choosing the appropriate technique for closure of the fascia as a preventive measure, especially in terms of an undesirable situation such as dehiscence, which has a direct effect on patient morbidity and mortality; It will also prevent the development of complications that increase financial burdens such as pain, mental problems, infection and reduce the necessity of reoperation 7 . A 2002 meta-analysis found no difference between continuous and primary sutures in terms of postoperative disruption of fascia integrity 8 . Full layer closure was described by Smead in 1900 and Jones in 1941 and later named the Smead-Jones technique. This method was improved by Professor Hughes with the modification of far and close sutures 9 . The fascia is brought closer to each other with the help of a distal bite starting from 2 cm on the edge of the linea from the outside to the inside, followed by a closer bite of 0.5 cm on the opposite side from the inside out, an inside-out bite closer to the incision line from the first entry point and an inside-out bite at a more distal point on the opposite side. Then, 1 cm below the first bite, the suture technique is repeated continuously in the same way (Fig. 1 ) 10 . In a prospective study of 403 patients, the Smead Jones technique was shown to be superior to other techniques in terms of incision dehiscence, wound infection, postoperative pulmonary infection and abdominal distension 11 . The Visual Analgesic Scale (VAS) is a valuable tool for assessing pain intensity and subjective experiences in a variety of medical contexts, including cesarean section (C-section) procedures. It has been used to assess pain reduction during labor and postoperative analgesic requirements in women undergoing caesarean section 12 . In our study, VAS score was used for postoperative pain assessment. MATERIALS AND METHODS The study was initiated after the approval decision dated 19.10.2023 and numbered 2023-02/4 was received from Erzincan Binali Yıldırım University Clinical Research Ethics Committee. The trial 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. Mean case duration and postoperative analgesic drug requirement and use were also evaluated. Statistical Analysis SPSS 27.0 program was used for statistical analysis and ratios, Kolmogorov-Smirnov analysis was used to evaluate the normal distribution of continuous variables, data showing normal distribution were shown as mean ± standard deviation and independent t test was used for analysis. Categorical variables were presented as number (%) and chi-square test was used to evaluate the differences between them. A value of p < 0.05 was considered statistically significant. When similar studies in the literature were evaluated for the sample size and Type 1 error (α) = 0.05, power (1-β) = 0.95, and effect size 0.851 were accepted; the number of people to be included in the study was determined as 74. Findings A total of 147 patients who met the inclusion and exclusion criteria within the specified time interval were included in the study. The age of the patients ranged between 18 and 43 years with a mean of 28.38 ± 4.94; height between 150 and 175 years with a mean of 160.96 ± 5.19; weight between 51 and 120 kg with a mean of 76.82 ± 13.70. Weeks of gestation ranged between 35 and 40 weeks and the mean was 38.02 ± 1.63. Infant birth weights ranged between 2300 and 4380 g and the mean was 3096 ± 363 g. In terms of weight gain during pregnancy, it ranged between 0 and 30 kg and the mean weight gain was 12.92 ± 5.56. The number of gravida was 2.37 ± 1.19, the number of parity was 1.29 ± 0.93 and the number of survivors was 1.27 ± 0.89. The number of cesarean sections ranged between 0 and 3 with a mean of 1.08 ± 0.85. In terms of indications for cesarean section, 57.1% had cesarean section for previous and repeated cesarean section, 6.8% for non-progressive labor, 17% for fetal distress, 10.8% for cephalopelvic incompatibility and the remaining 8.9% for other reasons. All patients were operated under spinal anesthesia and those operated under general anesthesia and those who underwent transversus abdominis plan (TAP) block were excluded. The mean cesarean time was 34.6 ± 7.4 min. Patients were asked to rate their pain by showing the visual pain scoring table at the 1st, 6th and 24th postoperative hours and when the patient groups were evaluated jointly, the 1st hour VAS was 6.56 ± 2.5, 6th hour VAS was 5.93 ± 1.9 and 24th hour VAS was 3.89 ± 1.7.(Table 1 ) Table 1 Descriptive Values by Groups Patient Group N (Number) Mean (median) Std. Deviation Age Smead Jones 75 29,09 4,796 Control 72 27,64 5,025 Boy Smead Jones 75 161,11 4,881 Control 72 160,81 5,535 Weight Smead Jones 75 78,73 13,469 Control 72 74,82 13,760 Birth Week Smead Jones 75 37,63 1,422 Control 72 38,43 1,751 Weight Gained during Pregnancy Smead Jones 75 12,19 4,501 Control 72 13,68 6,428 Baby Birth Weight Smead Jones 75 3041,33 350,233 Control 72 3153,19 371,030 Gravida Smead Jones 75 2,35 1,133 Control 72 2,40 1,263 Parity Smead Jones 75 1,23 0,746 Control 72 1,36 1,104 Living Smead Jones 75 1,21 0,741 Control 72 1,33 1,035 Number of CS Smead Jones 75 1,33 0,794 Control 72 0,82 0,845 Breastfeeding Smead Jones 75 1,08 0,273 Control 72 1,19 0,399 VAS Hour 1 Smead Jones 75 5,53 2,451 Control 72 7,64 2,164 VAST Hour 6 Smead Jones 75 5,24 1,575 Control 72 6,64 2,002 VAS 24th hour Smead Jones 75 3,12 1,315 Control 72 4,69 1,881 When the patients were divided into two groups as those whose fascia was closed with classical continuous closure and those whose fascia was closed with the Smead Jones technique; in the Smead Jones group consisting of 75 patients, mean age was 29.09 ± 4.7 years; mean height was 161.11 ± 4.8; mean weight 78 ± 13.4; mean gestational age 37 ± 1.42; mean gestational weight gain 12.19 ± 4.50; mean infant weight 3041 ± 350 g; mean gravida-parity and number of survivors 2.35 ± 1.13, 1.23 ± 0.74, 1.21 ± 0.74, respectively. The mean number of cesarean sections was 1.33 ± 0.79. The mean cesarean section duration was 34.25 ± 5.7 min, the need for extra analgesics other than nonsteroidal analgesics used routinely at 6 and 12 hours was 17%. 93% patients were breastfeeding within the first 24 hours. VAS at 1 hour was 5.53 ± 2.45; VAS at 6 hours was 5.24 ± 1.57 and VAS score at 24 hours was 3.12 ± 1.31. There were 72 patients who met the inclusion and exclusion criteria in the continiu suture group, which was our classical closure technique. The mean age of the patients in the control group was 27.64 ± 5.02 years; mean height was 160.8 ± 5.53 years; mean weight was 74.82 ± 13.76; mean gestational age was 38 ± 1.75 years; mean weight gained during pregnancy was 13.68 ± 6.42 years; mean baby weight was 3153 ± 371 g; mean gravida-parity and number of survivors were 2.4 ± 1.26, 1.36 ± 1.10, 1.33 ± 1.03, respectively. The mean number of cesarean sections was 1.82 ± 0.84. The mean duration of cesarean section was 32.25 ± 7.2 min, and the rate of extra analgesic use was 32%, except for nsai analgesics routinely used at 6 and 12 hours. 77% patients were breastfeeding within the first 24 hours. VAS at 1 hour was 7.64 ± 2.16, at 6 hours was 6.64 ± 2.00 and at 24 hours was 4.69 ± 1.88 (Table 2 ). Table 2 Comparison of Groups Sig. (p value) (Significance) Std. Error Difference (Std. Error Difference) Age Equal variances assumed 0,938 0,810 Equal variances not assumed 0,811 Boy Equal variances assumed 0,099 0,860 Equal variances not assumed 0,862 Weight Equal variances assumed 0,760 2,246 Equal variances not assumed 2,247 Birth Week Equal variances assumed 0,030 0,263 Equal variances not assumed 0,264 Weight Gained during Pregnancy Equal variances assumed 0,009 0,912 Equal variances not assumed 0,919 Baby Birth Weight Equal variances assumed 0,913 59,490 Equal variances not assumed 59,561 Gravida Equal variances assumed 0,115 0,198 Equal variances not assumed 0,198 Parity Equal variances assumed 0,015 0,155 Equal variances not assumed 0,156 Living Equal variances assumed 0,022 0,148 Equal variances not assumed 0,149 Number of CS Equal variances assumed 0,450 0,135 Equal variances not assumed 0,135 Breastfeeding Equal variances assumed 0,000 0,056 Equal variances not assumed 0,057 VAS Hour 1 Equal variances assumed 0,365 0,382 Equal variances not assumed 0,381 VAST Hour 6 Equal variances assumed 0,007 0,297 Equal variances not assumed 0,298 VAS 24th hour Equal variances assumed 0,032 0,267 Equal variances not assumed 0,269 When the groups were compared with each other, there was no significant difference between the two groups in terms of age, height, weight, weight gained during pregnancy, infant birth weight, gavida-parity and number of survivors (p > 0.05). The groups were similar in terms of indications for cesarean section, chronic disease status and physical activity. In terms of weeks of labor, the control group had a higher number of weeks and there was a significant difference of p = 0.03. 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. DISCUSSION In a study by Agrawal et al. no significant difference was found between primary suture and Smead Jones in terms of wound dehiscence 10 . However, in cases such as intraperitoneal sepsis, cough, uremia, wound infection and linea alba necrosis, primary closure of the fascia has been reported to reduce the risk of abdominal opening by 1/3. Although no postoperative complications were encountered in this study, the need for postoperative medical treatment was less in the Smead Jones group, which was considered to be superior to primary closure. There are studies investigating the effect of previous surgery on subsequent postoperative pain. In a study by Gramke et al., a high rate of postoperative pain after surgery was observed in patients with a history of previous surgery, indicating the potential effect of previous surgical experiences on subsequent pain perception 13 . In the present study, patients in the Smead Jones group had more previous surgical history and less postoperative pain and analgesia requirement. Accordingly, it can be concluded that the Smead Jones technique has a favorable effect on pain compared to traditional continuous sutured fascia closure. In a study of 90 patients, Ahi et al. compared continuous and intermittent X suture with the modified Smead Jones technique for closure of midline laparotomy wounds. Eleven of thirty patients (36.7%) with continuous suturing developed dehiscence, while four of thirty patients (13.3%) with intermittent X suturing and four of thirty patients (13.3%) with modified Smead Jones technique had dehiscence 14 . In a study by Aghara et al. a statistically significant difference was found between Smead Jones and traditional continuous suture method in terms of the risk of wound infection and wound dehiscence. The modified Smead Jones technique was compared with traditional continuous suture and fascia closure and it was concluded that the Smead Jones technique was better in terms of wound infection and dehiscence. However, there was no significant difference between the two methods in terms of wound dehiscence and reoperation for incisional hernia. The Smead Jones method was also found to reduce the mean length of hospital stay compared to the traditional continuous closure method 7 . Although it is plausible that the Smead Jones technique is more durable due to two passes (near and far) in a single focus compared to primary suture, it could not be compared with the literature since no complications were encountered in our study. The Smead Jones technique may be thought to shorten the length of hospitalization due to its significant success in the development of postoperative complications. However, since all cesarean sections in our clinic were under observation for 48 hours postoperatively, no conclusion about the length of stay was obtained in this study. In a study of 50 patients including emergency and elective cesarean sections, it was stated that opioid agents were required in addition to nonsteroidal anti-inflammatory analgesics after cesarean section 15 . In our study, 6 and 24 hour pain scores were lower and significant in the Smead Jones sutured group, which is a prediction that it may be beneficial in terms of postoperative pain control. In addition, the fact that patients with a history of previous surgery were more in the Smead Jones group. Chronic pain after surgery can last around 12 months. It can have consequences that affect the mother and the baby. In a Chinese study, about 80%, 35% and 3% of those with persistent pain reported moderate to severe pain on movement at 3, 6 and 12 months after surgery, respectively 16 . These results show how valuable postoperative pain control is. In this study, although there was no significant difference at 1 hour according to visual pain scoring (VAS), the value of the Smead Jones group at 6 and 24 hours was statistically significant and lower than the continuous suture (p < 0.01). It suggests that a technique with less postoperative pain may pose a lower risk of chronic postoperative pain. In terms of fascia repair, a number of different methods of primary closure have been tried to prevent incisional hernia formation. In an experimental study conducted by Meeks et al., the primary repair method was compared with the Smead Jones method and although the Smead Jones method took longer, it was statistically more effective 17 . Although there is no study on cesarean section duration in the literature, in this study, the difference between the two techniques was found to be approximately 2 minutes and this duration was not significant. The Smead Jones technique, which has a lower risk of complications, seems to be preferable to the traditional continuous suture, especially depending on the skill of the surgeon and the effectiveness of the excision. In a study of 116 patients conducted in 2004, it was reported that fascia closure with the Smead Jones technique decreased the risk of mortality and hernia in cases involving small and medium incisions, and decreased recurrence in cases of hernia repair 18 . Since there is no study in the literature investigating the Smead Jones technique in cesarean section operations and our study did not include postoperative complications, more detailed studies on recurrence would be appropriate. CONCLUSION Today, 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 large abdominal operations. In order to prevent complications, it is very important to choose the most appropriate operation technique for the patient. 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. More comprehensive studies on the subject will be effective in the surgical preferences of clinicians. Declarations Funding acquisition: Betül Kalkan YILMAZ, Okay ALPTEKİN Author Contribution Authorship ContributionsConceptualization: BK, Data curation: BK, Formal Analysis: BK, Funding acquisition: BK,OA, Investigation: BK, OAMethodology: BK, Resources: BK, OA, Software: BK, Supervision: OA, Validation: BK, OA, Visualization: BK, Writing -original draft: BK, OA, Writing-review& editing: BK, OAWe declare this work was done by the authors named in this article and all liabilities pertaining to claims relating to content of this article will be borne by the authors. All authors read and approved the Manuscript For Publication. We declare this work was done by the authors named in this article and all liabilities pertaining to claims relating to content of this article will be borne by the authors. All authors read and approved the manuscript for publication. References WHO. Caesarean section rates continue to rise, amid growing inequalities in access. Updated 16/06/2021. 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Tidsskr Nor Laegeforen . May 5 2020;140(7)Postoperativ smerte etter keisersnitt. doi:10.4045/tidsskr.19.0506 Jin J, Peng L, Chen Q, et al. Prevalence and risk factors for chronic pain following cesarean section: a prospective study. BMC Anesthesiol . Oct 18 2016;16(1):99. doi:10.1186/s12871-016-0270-6 Meeks GR, Nelson KC, Byars RW. Wound strength in abdominal incisions: a comparison of two continuous mass closure techniques in rats. American journal of obstetrics and gynecology . 1995;173(6):1676-1683. Shukla VK, Mongha R, Gupta N, Chauhan VS, Puneet. Incisional hernia--comparison of mesh repair with Cardiff repair: an university hospital experience. Hernia . Oct 2005;9(3):238-41. doi:10.1007/s10029-005-0326-x Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5883276","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":414688483,"identity":"e0cb9a80-453c-4e2d-b6c2-375b91147cdc","order_by":0,"name":"betül Kalkan","email":"data:image/png;base64,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","orcid":"","institution":"Erzincan Binali Yıldırım University","correspondingAuthor":true,"prefix":"","firstName":"betül","middleName":"","lastName":"Kalkan","suffix":""},{"id":414688486,"identity":"58735bd1-4734-49e6-b893-6c0f10eb7daa","order_by":1,"name":"okay alptekin","email":"","orcid":"","institution":"Erzincan Binali Yıldırım University","correspondingAuthor":false,"prefix":"","firstName":"okay","middleName":"","lastName":"alptekin","suffix":""}],"badges":[],"createdAt":"2025-01-22 19:23:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5883276/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5883276/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":76282978,"identity":"41f5635f-d2d9-41b8-9d2e-2a7f3c6e207f","added_by":"auto","created_at":"2025-02-14 10:52:22","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":24520,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSmead Jones Technique\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5883276/v1/9d196960d7cfdbc294c5f076.png"},{"id":77258812,"identity":"b0bbabca-cfdb-4e9d-b840-ddf7a9b6a983","added_by":"auto","created_at":"2025-02-26 18:16:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":614066,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5883276/v1/1f6473e9-b7dd-43be-8e3f-b18997eb4777.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Effect of Fascia Closure with Smead-Jones Technique on Postoperative Pain During Cesarean Section","fulltext":[{"header":"Key Points","content":"\u003cp\u003e\u003cstrong\u003eQuestion:\u0026nbsp;\u003c/strong\u003eWhat is the effect of fascia closure with the Smead Jones method on postoperative pain?\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFindings:\u0026nbsp;\u003c/strong\u003eThis study is a prospective clinical trial with 147 patients divided into 2 groups, which has not been done before in the literature. The study concluded that the need for postoperative analgesics was statistically significant and less in the Smead Jones group.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeaning:\u0026nbsp;\u003c/strong\u003eSmead Jones technique may be used by obstetricians as it reduces postoperative pain and complications.\u003c/p\u003e"},{"header":"INTRODUCTION","content":"\u003cp\u003eCesarean section is one of the most common abdominal surgeries for women. According to the World Health Organization (WHO), 1 in 5 births is by caesarean section, and this rate is expected to reach 29% by 2030\u003csup\u003e1\u003c/sup\u003e. Pain control after an operation with such a high frequency is very valuable for both the patient and the baby. Postoperative pain plays an important role in patients' surgical experience. Patients are concerned and fearful about postoperative pain in the preoperative period\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Inadequate pain control leads to increased sympathetic nervous system stimulation. Increased pain leads to blood pressure spikes in postoperative hypertensive patients, potentially increasing the risk of cerebral hemorrhage and stroke\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. The risk of atelectasis and pneumonia decreases with good postoperative pain control, adequate ventilation, coughing and breathing exercises, and the risk of postoperative thrombophlebitis and embolism decreases with increased mobilization of the patient\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Postoperative pain is very important in terms of maternal and infant health, adequate contact and bonding, adequate nutrition of the baby and the recovery period of the mother. Chronic postoperative pain may affect the patient's daily activities and may cause deterioration in quality of life. Cesarean section is a common procedure and studies have shown that pain may persist up to 12 months postoperatively\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn terms of surgical procedures, there are vertical, oblique and transverse incisions for examining intra-abdominal pathologies. Incisions used in gynecologic surgery can be further divided into transverse and vertical incisions. Most of the incisions used for female genital organs are transverse incisions, which are preferred because they are stronger, less painful, have less risk of dehiscence and have better cosmetic results compared to midline incisions\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Since fascia repair in the postoperative incision is valuable for pain control, the choice of the suture technique to be applied is important. In addition to pain control, determination of the suture method that will minimize postoperative complications will increase patient comfort, shorten the duration of hospitalization and reduce the cost of treatment. Choosing the appropriate technique for closure of the fascia as a preventive measure, especially in terms of an undesirable situation such as dehiscence, which has a direct effect on patient morbidity and mortality; It will also prevent the development of complications that increase financial burdens such as pain, mental problems, infection and reduce the necessity of reoperation\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. A 2002 meta-analysis found no difference between continuous and primary sutures in terms of postoperative disruption of fascia integrity \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFull layer closure was described by Smead in 1900 and Jones in 1941 and later named the Smead-Jones technique. This method was improved by Professor Hughes with the modification of far and close sutures\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. The fascia is brought closer to each other with the help of a distal bite starting from 2 cm on the edge of the linea from the outside to the inside, followed by a closer bite of 0.5 cm on the opposite side from the inside out, an inside-out bite closer to the incision line from the first entry point and an inside-out bite at a more distal point on the opposite side. Then, 1 cm below the first bite, the suture technique is repeated continuously in the same way (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. In a prospective study of 403 patients, the Smead Jones technique was shown to be superior to other techniques in terms of incision dehiscence, wound infection, postoperative pulmonary infection and abdominal distension\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe Visual Analgesic Scale (VAS) is a valuable tool for assessing pain intensity and subjective experiences in a variety of medical contexts, including cesarean section (C-section) procedures. It has been used to assess pain reduction during labor and postoperative analgesic requirements in women undergoing caesarean section\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. In our study, VAS score was used for postoperative pain assessment.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003e The study was initiated after the approval decision dated 19.10.2023 and numbered 2023-02/4 was received from Erzincan Binali Yıldırım University Clinical Research Ethics Committee. The trial 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\u0026thinsp;\u0026gt;\u0026thinsp;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. Mean case duration and postoperative analgesic drug requirement and use were also evaluated.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eSPSS 27.0 program was used for statistical analysis and ratios, Kolmogorov-Smirnov analysis was used to evaluate the normal distribution of continuous variables, data showing normal distribution were shown as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and independent t test was used for analysis. Categorical variables were presented as number (%) and chi-square test was used to evaluate the differences between them. A value of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. When similar studies in the literature were evaluated for the sample size and Type 1 error (α)\u0026thinsp;=\u0026thinsp;0.05, power (1-β)\u0026thinsp;=\u0026thinsp;0.95, and effect size 0.851 were accepted; the number of people to be included in the study was determined as 74.\u003c/p\u003e \u003c/div\u003e"},{"header":"Findings","content":"\u003cp\u003eA total of 147 patients who met the inclusion and exclusion criteria within the specified time interval were included in the study. The age of the patients ranged between 18 and 43 years with a mean of 28.38\u0026thinsp;\u0026plusmn;\u0026thinsp;4.94; height between 150 and 175 years with a mean of 160.96\u0026thinsp;\u0026plusmn;\u0026thinsp;5.19; weight between 51 and 120 kg with a mean of 76.82\u0026thinsp;\u0026plusmn;\u0026thinsp;13.70. Weeks of gestation ranged between 35 and 40 weeks and the mean was 38.02\u0026thinsp;\u0026plusmn;\u0026thinsp;1.63. Infant birth weights ranged between 2300 and 4380 g and the mean was 3096\u0026thinsp;\u0026plusmn;\u0026thinsp;363 g. In terms of weight gain during pregnancy, it ranged between 0 and 30 kg and the mean weight gain was 12.92\u0026thinsp;\u0026plusmn;\u0026thinsp;5.56. The number of gravida was 2.37\u0026thinsp;\u0026plusmn;\u0026thinsp;1.19, the number of parity was 1.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93 and the number of survivors was 1.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89. The number of cesarean sections ranged between 0 and 3 with a mean of 1.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85. In terms of indications for cesarean section, 57.1% had cesarean section for previous and repeated cesarean section, 6.8% for non-progressive labor, 17% for fetal distress, 10.8% for cephalopelvic incompatibility and the remaining 8.9% for other reasons. All patients were operated under spinal anesthesia and those operated under general anesthesia and those who underwent transversus abdominis plan (TAP) block were excluded. The mean cesarean time was 34.6\u0026thinsp;\u0026plusmn;\u0026thinsp;7.4 min. Patients were asked to rate their pain by showing the visual pain scoring table at the 1st, 6th and 24th postoperative hours and when the patient groups were evaluated jointly, the 1st hour VAS was 6.56\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5, 6th hour VAS was 5.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.9 and 24th hour VAS was 3.89\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7.(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive Values by Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN (Number)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003cp\u003e(median)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStd. Deviation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmead Jones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29,09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4,796\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27,64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5,025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBoy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmead Jones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e161,11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4,881\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e160,81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5,535\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWeight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmead Jones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e78,73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13,469\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e74,82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13,760\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBirth Week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmead Jones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37,63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1,422\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38,43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1,751\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWeight Gained during Pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmead Jones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12,19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4,501\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13,68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6,428\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBaby Birth Weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmead Jones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3041,33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e350,233\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3153,19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e371,030\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGravida\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmead Jones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2,35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1,133\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2,40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1,263\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eParity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmead Jones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0,746\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1,104\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLiving\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmead Jones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0,741\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1,035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNumber of CS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmead Jones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0,794\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0,845\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBreastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmead Jones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0,273\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1,19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0,399\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVAS Hour 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmead Jones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5,53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2,451\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7,64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2,164\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVAST Hour 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmead Jones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5,24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1,575\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6,64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2,002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVAS 24th hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmead Jones\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3,12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1,315\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4,69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1,881\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhen the patients were divided into two groups as those whose fascia was closed with classical continuous closure and those whose fascia was closed with the Smead Jones technique; in the Smead Jones group consisting of 75 patients, mean age was 29.09\u0026thinsp;\u0026plusmn;\u0026thinsp;4.7 years; mean height was 161.11\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8; mean weight 78\u0026thinsp;\u0026plusmn;\u0026thinsp;13.4; mean gestational age 37\u0026thinsp;\u0026plusmn;\u0026thinsp;1.42; mean gestational weight gain 12.19\u0026thinsp;\u0026plusmn;\u0026thinsp;4.50; mean infant weight 3041\u0026thinsp;\u0026plusmn;\u0026thinsp;350 g; mean gravida-parity and number of survivors 2.35\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13, 1.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74, 1.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.74, respectively. The mean number of cesarean sections was 1.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79. The mean cesarean section duration was 34.25\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7 min, the need for extra analgesics other than nonsteroidal analgesics used routinely at 6 and 12 hours was 17%. 93% patients were breastfeeding within the first 24 hours. VAS at 1 hour was 5.53\u0026thinsp;\u0026plusmn;\u0026thinsp;2.45; VAS at 6 hours was 5.24\u0026thinsp;\u0026plusmn;\u0026thinsp;1.57 and VAS score at 24 hours was 3.12\u0026thinsp;\u0026plusmn;\u0026thinsp;1.31.\u003c/p\u003e \u003cp\u003eThere were 72 patients who met the inclusion and exclusion criteria in the continiu suture group, which was our classical closure technique. The mean age of the patients in the control group was 27.64\u0026thinsp;\u0026plusmn;\u0026thinsp;5.02 years; mean height was 160.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5.53 years; mean weight was 74.82\u0026thinsp;\u0026plusmn;\u0026thinsp;13.76; mean gestational age was 38\u0026thinsp;\u0026plusmn;\u0026thinsp;1.75 years; mean weight gained during pregnancy was 13.68\u0026thinsp;\u0026plusmn;\u0026thinsp;6.42 years; mean baby weight was 3153\u0026thinsp;\u0026plusmn;\u0026thinsp;371 g; mean gravida-parity and number of survivors were 2.4\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26, 1.36\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10, 1.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03, respectively. The mean number of cesarean sections was 1.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84. The mean duration of cesarean section was 32.25\u0026thinsp;\u0026plusmn;\u0026thinsp;7.2 min, and the rate of extra analgesic use was 32%, except for nsai analgesics routinely used at 6 and 12 hours. 77% patients were breastfeeding within the first 24 hours. VAS at 1 hour was 7.64\u0026thinsp;\u0026plusmn;\u0026thinsp;2.16, at 6 hours was 6.64\u0026thinsp;\u0026plusmn;\u0026thinsp;2.00 and at 24 hours was 4.69\u0026thinsp;\u0026plusmn;\u0026thinsp;1.88 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSig. (p value)\u003c/p\u003e \u003cp\u003e(Significance)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStd. Error Difference\u003c/p\u003e \u003cp\u003e(Std. Error Difference)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0,938\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,810\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances not assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,811\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBoy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0,099\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,860\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances not assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,862\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWeight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0,760\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2,246\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances not assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2,247\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBirth Week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0,030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,263\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances not assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,264\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWeight Gained during Pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0,009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,912\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances not assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,919\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBaby Birth Weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0,913\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59,490\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances not assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59,561\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGravida\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0,115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,198\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances not assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,198\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eParity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0,015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,155\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances not assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,156\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLiving\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0,022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,148\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances not assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,149\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNumber of CS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0,450\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,135\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances not assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,135\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBreastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,056\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances not assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVAS Hour 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0,365\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,382\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances not assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,381\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVAST Hour 6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0,007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,297\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances not assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,298\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVAS 24th hour\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0,032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,267\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEqual variances not assumed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,269\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhen the groups were compared with each other, there was no significant difference between the two groups in terms of age, height, weight, weight gained during pregnancy, infant birth weight, gavida-parity and number of survivors (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The groups were similar in terms of indications for cesarean section, chronic disease status and physical activity. In terms of weeks of labor, the control group had a higher number of weeks and there was a significant difference of p\u0026thinsp;=\u0026thinsp;0.03. In terms of total number of cesarean sections, the number of cesarean sections in the study (Smead Jones) group was significantly higher (p\u0026thinsp;\u0026lt;\u0026thinsp;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\u0026thinsp;\u0026lt;\u0026thinsp;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.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn a study by Agrawal et al. no significant difference was found between primary suture and Smead Jones in terms of wound dehiscence\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. However, in cases such as intraperitoneal sepsis, cough, uremia, wound infection and linea alba necrosis, primary closure of the fascia has been reported to reduce the risk of abdominal opening by 1/3. Although no postoperative complications were encountered in this study, the need for postoperative medical treatment was less in the Smead Jones group, which was considered to be superior to primary closure.\u003c/p\u003e \u003cp\u003eThere are studies investigating the effect of previous surgery on subsequent postoperative pain. In a study by Gramke et al., a high rate of postoperative pain after surgery was observed in patients with a history of previous surgery, indicating the potential effect of previous surgical experiences on subsequent pain perception\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. In the present study, patients in the Smead Jones group had more previous surgical history and less postoperative pain and analgesia requirement. Accordingly, it can be concluded that the Smead Jones technique has a favorable effect on pain compared to traditional continuous sutured fascia closure.\u003c/p\u003e \u003cp\u003eIn a study of 90 patients, Ahi et al. compared continuous and intermittent X suture with the modified Smead Jones technique for closure of midline laparotomy wounds. Eleven of thirty patients (36.7%) with continuous suturing developed dehiscence, while four of thirty patients (13.3%) with intermittent X suturing and four of thirty patients (13.3%) with modified Smead Jones technique had dehiscence\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. In a study by Aghara et al. a statistically significant difference was found between Smead Jones and traditional continuous suture method in terms of the risk of wound infection and wound dehiscence. The modified Smead Jones technique was compared with traditional continuous suture and fascia closure and it was concluded that the Smead Jones technique was better in terms of wound infection and dehiscence. However, there was no significant difference between the two methods in terms of wound dehiscence and reoperation for incisional hernia. The Smead Jones method was also found to reduce the mean length of hospital stay compared to the traditional continuous closure method\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Although it is plausible that the Smead Jones technique is more durable due to two passes (near and far) in a single focus compared to primary suture, it could not be compared with the literature since no complications were encountered in our study. The Smead Jones technique may be thought to shorten the length of hospitalization due to its significant success in the development of postoperative complications. However, since all cesarean sections in our clinic were under observation for 48 hours postoperatively, no conclusion about the length of stay was obtained in this study.\u003c/p\u003e \u003cp\u003eIn a study of 50 patients including emergency and elective cesarean sections, it was stated that opioid agents were required in addition to nonsteroidal anti-inflammatory analgesics after cesarean section\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. In our study, 6 and 24 hour pain scores were lower and significant in the Smead Jones sutured group, which is a prediction that it may be beneficial in terms of postoperative pain control. In addition, the fact that patients with a history of previous surgery were more in the Smead Jones group.\u003c/p\u003e \u003cp\u003eChronic pain after surgery can last around 12 months. It can have consequences that affect the mother and the baby. In a Chinese study, about 80%, 35% and 3% of those with persistent pain reported moderate to severe pain on movement at 3, 6 and 12 months after surgery, respectively\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. These results show how valuable postoperative pain control is. In this study, although there was no significant difference at 1 hour according to visual pain scoring (VAS), the value of the Smead Jones group at 6 and 24 hours was statistically significant and lower than the continuous suture (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). It suggests that a technique with less postoperative pain may pose a lower risk of chronic postoperative pain.\u003c/p\u003e \u003cp\u003eIn terms of fascia repair, a number of different methods of primary closure have been tried to prevent incisional hernia formation. In an experimental study conducted by Meeks et al., the primary repair method was compared with the Smead Jones method and although the Smead Jones method took longer, it was statistically more effective\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Although there is no study on cesarean section duration in the literature, in this study, the difference between the two techniques was found to be approximately 2 minutes and this duration was not significant. The Smead Jones technique, which has a lower risk of complications, seems to be preferable to the traditional continuous suture, especially depending on the skill of the surgeon and the effectiveness of the excision.\u003c/p\u003e \u003cp\u003eIn a study of 116 patients conducted in 2004, it was reported that fascia closure with the Smead Jones technique decreased the risk of mortality and hernia in cases involving small and medium incisions, and decreased recurrence in cases of hernia repair\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Since there is no study in the literature investigating the Smead Jones technique in cesarean section operations and our study did not include postoperative complications, more detailed studies on recurrence would be appropriate.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eToday, 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 large abdominal operations. In order to prevent complications, it is very important to choose the most appropriate operation technique for the patient. 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. More comprehensive studies on the subject will be effective in the surgical preferences of clinicians.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eacquisition: Bet\u0026uuml;l Kalkan YILMAZ, Okay ALPTEKİN\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthorship ContributionsConceptualization: BK, Data curation: BK, Formal Analysis: BK, Funding acquisition: BK,OA, Investigation: BK, OAMethodology: BK, Resources: BK, OA, Software: BK, Supervision: OA, Validation: BK, OA, Visualization: BK, Writing -original draft: BK, OA, Writing-review\u0026amp; editing: BK, OAWe declare this work was done by the authors named in this article and all liabilities pertaining to claims relating to content of this article will be borne by the authors. All authors read and approved the Manuscript For Publication.\u003c/p\u003e\u003cp\u003eWe declare this work was done by the authors named in this article and all liabilities pertaining to claims relating to content of this article will be borne by the authors. All authors read and approved the manuscript for publication.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWHO. Caesarean section rates continue to rise, amid growing inequalities in access. Updated 16/06/2021. Accessed 31/01/2024, 2024. https://www.who.int/news/item/16-06-2021-caesarean-section-rates-continue-to-rise-amid-growing-inequalities-in-access\u003c/li\u003e\n\u003cli\u003eSj\u0026ouml;ling M, Nordahl G, Olofsson N, Asplund K. The impact of preoperative information on state anxiety, postoperative pain and satisfaction with pain management. \u003cem\u003ePatient education and counseling\u003c/em\u003e. 2003;51(2):169-176.\u003c/li\u003e\n\u003cli\u003eSivam N, Suresh S, Hadke M, Kate V, Ananthakrishnan N. Results of the Smead-Jones technique of closure of vertical midline incisions for emergency laparotomies--a prospective study of 403 patients. \u003cem\u003eTropical Gastroenterology: Official Journal of the Digestive Diseases Foundation\u003c/em\u003e. 1995;16(4):62-67.\u003c/li\u003e\n\u003cli\u003eMorgan GE, Mikhail MS, Murray MJ, Larson C. The practice of anesthesiology. \u003cem\u003eClinical anesthesiology\u003c/em\u003e. 2002;3\u003c/li\u003e\n\u003cli\u003eJin J, Peng L, Chen Q, et al. Prevalence and risk factors for chronic pain following cesarean section: a prospective study. \u003cem\u003eBMC anesthesiology\u003c/em\u003e. 2016;16(1):1-11.\u003c/li\u003e\n\u003cli\u003eRock JA, Jones HW, Te Linde RW, Demir SC, Tıraş MB. \u003cem\u003eTe Linde Operatif jinekoloji\u003c/em\u003e. vol Jinekolojik Cerrahi İnsizyonları. G\u0026uuml;neş Tıp Kitabevi; 2017:217-219.\u003c/li\u003e\n\u003cli\u003eAghara CB, Rajyaguru AM, Bhatt JG. Prospective comparative study of modified Smead Jones versus conventional continuous method of fascial closure in emergency midline laparotomy. \u003cem\u003eInternational Surgery Journal\u003c/em\u003e. 2020;7(11):3713-3717.\u003c/li\u003e\n\u003cli\u003evan \u0026apos;t Riet M, Steyerberg EW, Nellensteyn J, Bonjer HJ, Jeekel J. Meta-analysis of techniques for closure of midline abdominal incisions. \u003cem\u003eBr J Surg\u003c/em\u003e. Nov 2002;89(11):1350-6. doi:10.1046/j.1365-2168.2002.02258.x\u003c/li\u003e\n\u003cli\u003e\u0026Ccedil;etinkaya K, İnge\u0026ccedil; M. KADIN HASTALIKLARI VE DOĞUM KLİNİĞİNDE 2006-2008 YILLARI KESİ YERİ AYRILMASI OLAN OLGULARIN DEĞERLENDİRİLMESİ VE LİTERAT\u0026Uuml;R ARAŞTIRMASI.\u003c/li\u003e\n\u003cli\u003eAgrawal CS, Tiwari P, Mishra S, et al. Interrupted abdominal closure prevents burst: randomized controlled trial comparing interrupted-x and conventional continuous closures in surgical and gynecological patients. \u003cem\u003eIndian J Surg\u003c/em\u003e. Aug 2014;76(4):270-6. doi:10.1007/s12262-012-0611-8\u003c/li\u003e\n\u003cli\u003eKalkman C, Visser K, Moen J, Bonsel G, Grobbee D, Moons K. Preoperative prediction of severe postoperative pain. \u003cem\u003ePain\u003c/em\u003e. 2003;105(3):415-423.\u003c/li\u003e\n\u003cli\u003eDuan G, Yang G, Peng J, et al. Comparison of Postoperative Pain Between Patients Who Underwent Primary and Repeated Cesarean Section: A Prospective Cohort Study. \u003cem\u003eBMC Anesthesiology\u003c/em\u003e. 2019;doi:10.1186/s12871-019-0865-9\u003c/li\u003e\n\u003cli\u003eGramke H-F, Rijke JMd, Kleef Mv, et al. The Prevalence of Postoperative Pain in a Cross-Sectional Group of Patients After Day-Case Surgery in a University Hospital. \u003cem\u003eClinical Journal of Pain\u003c/em\u003e. 2007;doi:10.1097/ajp.0b013e318074c970\u003c/li\u003e\n\u003cli\u003eAhi KS, Khandekar SM, Mittal SK, et al. Prevention of burst abdomen by interrupted closure: a comparative study of conventional continuous versus interrupted-X-type versus hughes far-and-near interrupted abdominal fascial closure in surgical patients. \u003cem\u003eISOR J\u003c/em\u003e. 2017;16:21-30.\u003c/li\u003e\n\u003cli\u003eBj\u0026oslash;rnstad J, R\u0026aelig;der J. Post-operative pain after caesarean section. \u003cem\u003eTidsskr Nor Laegeforen\u003c/em\u003e. May 5 2020;140(7)Postoperativ smerte etter keisersnitt. doi:10.4045/tidsskr.19.0506\u003c/li\u003e\n\u003cli\u003eJin J, Peng L, Chen Q, et al. Prevalence and risk factors for chronic pain following cesarean section: a prospective study. \u003cem\u003eBMC Anesthesiol\u003c/em\u003e. Oct 18 2016;16(1):99. doi:10.1186/s12871-016-0270-6\u003c/li\u003e\n\u003cli\u003eMeeks GR, Nelson KC, Byars RW. Wound strength in abdominal incisions: a comparison of two continuous mass closure techniques in rats. \u003cem\u003eAmerican journal of obstetrics and gynecology\u003c/em\u003e. 1995;173(6):1676-1683.\u003c/li\u003e\n\u003cli\u003eShukla VK, Mongha R, Gupta N, Chauhan VS, Puneet. Incisional hernia--comparison of mesh repair with Cardiff repair: an university hospital experience. \u003cem\u003eHernia\u003c/em\u003e. Oct 2005;9(3):238-41. doi:10.1007/s10029-005-0326-x\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"cesarean section, Smead Jones, postoperative pain","lastPublishedDoi":"10.21203/rs.3.rs-5883276/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5883276/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction: \u003c/strong\u003eThe\u003cstrong\u003e \u003c/strong\u003eseverity 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterial and method: \u003c/strong\u003eThe 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\u0026gt;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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA 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\u0026lt;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\u0026lt;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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eDespite 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.\u003c/p\u003e","manuscriptTitle":"The Effect of Fascia Closure with Smead-Jones Technique on Postoperative Pain During Cesarean Section","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-14 10:52:17","doi":"10.21203/rs.3.rs-5883276/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7444fe36-be12-4bae-b9a4-e645908c61ec","owner":[],"postedDate":"February 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-26T18:08:08+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-14 10:52:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5883276","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5883276","identity":"rs-5883276","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}