Anticipate the many challenges of cesarean section in superobese
EXPERT ANALYSIS FROM THE SOGH ANNUAL CLINICAL MEETING
"I would abandon the practice if I were you," the ob.gyn. advised.
Similarly, negative pressure dressings sound like a good idea but have proved disappointing in randomized clinical trials.
Dr. Alanis favors delayed closure. He’ll pack the wound for 3-4 days while granulation tissue forms, and then sew the wound closed in the office.
• Managing wound complications. To Dr. Alanis’ surprise, factors that proved unrelated to the risk of wound complications in his study of the superobese included labor as opposed to nonlabor, labor duration, rupture of membranes, chorioamnionitis, operative time, and emergent vs. routine vs. urgent cesarean section. Indeed, the only predictors of wound complications in his series were subcutaneous drains, associated with a 2.4-fold increased risk, and smoking, with a 2.9-fold elevated risk.
Eighty-six percent of wound complications in the superobese women were diagnosed post discharge. Wound disruption was diagnosed on median postoperative day 8.5. A total of 24% of patients with a wound complication were readmitted; 14% underwent reoperation.
Delayed closure is a very attractive way to manage seromas and hematomas. It requires healthy pink tissue and is not a technique for patients with a postoperative abscess.
Dr. Alanis reported having no financial interests germane to his presentation.
