Comparison of the Joel-Cohen-based technique and the transverse Pfannenstiel for caesarean section for safety and effectiveness: A systematic review and meta-analysis

Background: Caesarean section (C-section) is the most common surgery among women worldwide, and the global rate of this surgical procedure has been continuously rising. Hence, it is significantly crucial to develop and apply highly effective and safe caesarean section techniques. In this review study, we aimed at assessing the safety and effectiveness of the Joel-Cohen-based technique and comparing the results with the transverse Pfannenstiel incision for C-section. Methods: In this study, various reliable databases such as the PubMed Central, COCHRANE, DARE, and Ovid MEDLINE were targeted. Reviews, systematic reviews, and randomized clinical trial studies comparing the Joel-Cohen-based technique and the transverse Pfannenstiel incision were selected based on the inclusion criteria. Selected studies were checked by 2 independent reviewers based on the inclusion criteria, and the quality of these studies was assessed. Then, their data were extracted and analyzed. Results: Five randomized clinical trial studies met the inclusion criteria. According to the exiting evidence, statistical results of the Joel-Cohen-based technique showed that this technique is more effective compared to the transverse Pfannenstiel incision. Metaanalysis results of the 3 outcomes were as follow: operation time (5 trials, 764 women; WMD -9.78; 95% CI:-14.49-5.07 minutes, p<0.001), blood loss (3 trials, 309 women; WMD -53.23ml; 95% –CI: 90.20-16.26 ml, p= 0.004), and post-operative hospital stay (3 trials, 453 women; WMD -.69 day; 95% CI: 1.4-0.03 day, p<0.001). Statistical results revealed a significant difference between the 2 techniques. Conclusion: According to the literature, despite having a number of side effects, the Joel-Cohen-based technique is generally more effective than the Pfannenstiel incision technique. In addition, it was recommended that the Joel-Cohen-based technique be used as a replacement for the Pfannenstiel incision technique according to the surgeons’ preferences and the patients’ conditions.