The misgav ladach method - method of choice of cesarean section for developing countries

Introduction
Among obstetric techniques, cesarean section seemed to represent a well-defined procedures and significant advances in this intervention were considered to be unlikely. But during the last time obstetric surgery has undergone many improvements. In the 1970s Joel-Cohen presented a new method for opening the abdomen [1] This method is the result of critical assessment of each surgical step.
It is performed by a superfitial transverse cut in the cutis, two to three cm below the line between the anterior and superior spinae illiacae; deepening the cut in midline with a scalpel to expose the fascia; dissecting fascia laterally below the fat tissue with scissors; then manual bilateral traction of the recti muscles and the subcutis at the same time. The parietal peritoneum is opened manual transversaly to avoid demage of the bladder. After the delivery, the abdomen is closed by a continuous suture of the fascia, and few, widely spaced stitches in the scin.
One of the most important step is the leaving non-sutured visceral and parietal peritoneum. Namely, peritoneal repair of surgical defects occurs simultaneously in multiple sites by migration of mesothelial cells into supportive matrix. Reestablishment of the peritoneal layer is observed within 72 h of surgery and complete repair occurs within 1 week where the peritoneum is leaving unsuturecl because of avoid ischaemia, necrosis, foreign body reaction [6]. In the case of sutured peritoneum normal fibrinolytic activity is suppressed under ischaemic conditions. Fibrin that is not resorbed becomes stabilised, infiltrated by fibroblasts, and ultimately organised into permanent adhesions [7
Advantages of this metod are: less ferquency of fever and urinary tract infection as well as the administration of therapeutic antibiotics and narcotics, mean time to positive auscultation of bowel sounds, shorter maternal hospital stay and avoiding postoperative adhesion formation [5].