Meta-analysis Of Comparison Between Two Kinds Of Cesarean Section In Repeated Cesarean Section

Objective: The aim of this study was to comprehensively evaluate the advantages and disadvantages of extraperitoneal cesarean section(ECS)and intraperitoneal cesarean section(TCS)in repeated cesarean section,to provide evidence-based medicine for the choice of surgical methods for the patients with cesarean section again.Methods: PubMed,Web of Science,Medline,Embase,China Biomedical Literature Database,China Knowledge Network,Wanfang database and WIP database were searched by computer.The search period was from January 2008 to December 2019.The search terms: extraperitoneal cesarean section,intraperitoneal cesarean section,secondary cesarean section,re-cesarean section.According to the purpose of the study,the related Randomized controlled trial were selected,and the literatures were further selected according to the inclusion and exclusion criteria,the data was extracted and the quality was evaluated,and the revman 5.3 software was used for Meta analysis.Results: A total of 20 papers were selected in this study,all of which were inChina,including 3 prospective studies and 17 retrospective studies.The total sample size was 2453 cases,including 1202 cases in ECS group and 1251 cases in TCS group.Meta-analysis results showed that the advantages of ECS over TCS in the choice of re-cesarean section lied in shorter operation time[MD=-9.25,95%CI(-15.10 ~-3.40),P=0.002],less intraoperative bleeding[MD=-56.31,95%CI(-75.19 ~-37.43),P<0.00001],earlier postoperative feeding[MD=-4.39,95%CI(-5.38 ~-3.40),P<0.00001],the gastrointestinal function recovered earlier after operation[MD=-14.73,95%CI(-21.34 ~-8.12),P<0.0001],lower postoperative morbidity(24hours to 7 days after operation,2 discontinuities with body temperature≥38°C)[OR=0.29,95%CI(0.16 ~ 0.53),P<0.0001] and postoperative peak temperature [MD=-0.11,95%CI(-0.17 ~-0.05),P=0.0002],less operative complications: lower intestinal injury rate[OR=0.15,95%CI(0.03 ~ 0.85),P=0.03],lower bladder injury rate[OR=0.19,95%CI(0.04~0.88),P=0.03],and shorter hospital stay[MD=-2.29,95%CI(-2.69~-1.89),P<0.00001],above of all the differences were statisti cally significant.There were no significant differences in gross hematuria[OR=1.03,95%CI(0.49 ~ 2.17),P=0.94],neonatal asphyxia[OR=1.37,95%CI(0.76 ~2.47),P=0.29] and time from skin incision to fetal delivery[MD=-3.34,95%(-6.67~-0.00),P=0.05].Conclusion: Compared with an intraperitoneal cesarean section,extraperitoneal cesarean can shorten the operation time,reduce the amount of bleeding,promote the recovery of gastrointestinal function and eat earlier,reduce the morbidity and the peak temperature,reduce the complications and shorten the hospital stay.There was no significant difference in neonatal asphyxia rate,time from skin incision to fetal delivery,gross hematuria after operation.For patients with severe abdominal adhesions due to previous Cesarean section or other abdominal surgery history,an extraperitoneal approach may be a better option in repeated cesarean section.