腹膜外剖宫产术，臀位DR sudhansu 127.7mb

extraperitoneal cesarean section in breech presentation by dr sudhansu nanda

Procedure:
The patient can be given spinal anesthesia or general anesthesia as per need.
The bladder is catheterized.
Transverse pfannenstiel skin incision is made.
The rectus sheath is incised transversely
Recti are separated
After separation of the recti, transversalis fascia is separated until the right inferior epigastric vessels .
Transersalis fascia is pierced bluntly, medial to the inferior epigastric vessels, and the fascia is stretched to widen the opening
This exposes the lower segment covered with bladder
The lateral limit of the bladder is demarcated by medial umbilical ligament
The fat pad (the bladder cushion) lateral to the medial umbilical ligament is teased and bladder is pushed medially to expose the utero-vesical fold of peritoneum
Inferior to the fold is the cervico-vesical fascia which has two layers (the superficial layer
invests the posterior vesical surface and the deep layer invests the lower uterine segment)The superficial layer is opened with a knife and the space is created between it and deep layer to allow an easy access to the lower segment by pushing the bladder medially and downwards.
The uterus is incised transversely and the incision is extended with the help of fingers . The placenta and membranes are delivered
The uterus is sutured with number one polyglactin 910 in single layer.
Haemostasis is checked and achieved.
count, rectus muscles are approximated and rectus sheath closed with polygalctine number O.
The skin is closed with subcuticular stitch with 910 polygalactin rapid three zero, or polyamide 2-0.
Advantages:
As there is no bowel handling and as the pain is reduced and ileus is reduced
Intra-peritoneal infections are reduced
There is no chance of losing a surgical mop in the peritoneal cavity
Long term sequel as intra-peritoneal adhesions is reduced
The patient can be discharged 48 hours after the surgery