***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: EDITORIAL COMMENT : This vignette draws attention to a detail of surgical technique familiar to all surgeons who perform the Pfannenstiel incision .  Freeing the insertion of the pyramidalis muscles from the rectus sheath is often untidy and can cause considerable haemorrhage . Our literature search confirms the opinion of the review ers of this paper that nonfreeing of the lower leaf of the rectus sheath at Caesarean section is a new idea and so this brief ‘ r and omized controlled trial ’ was accepted for publication . One review er wondered if the trauma to the pyramidalis muscles often encountered at Caesarean section is due to variation in the level ( i.e. distance above pubic symphysis ) of the transverse skin incision , or variation in the anatomy of the pyramidalis muscles . Readers will accept the shorter time interval to reach the abdominal cavity with the technique described but may wonder if the time from entry of the abdomen to exit of the fetus from the uterus was affected , especially in cases of repeat Caesarean section where scar tissue might affect the ease of manipulation . One review er of this manuscript stated that the concept of not separating the rectus sheath from the underlying muscles is not entirely new since S. Joel Cohen advocated the technique in 1972 ( Joel Cohen , S. A technique of abdominal and vaginal hysterectomy based on time and motion studies . Heinemann , London 1972 , p10 ) OBJECTIVE A new technical variant of  caesarean section  was described a few years ago , which is characterised by blunt surgical preparation and simplified seam technique . A prospect i ve investigation compared the differences in the surgery and postoperative process as well as the rate of complications between this Misgav Ladach method and the conventional technique of Sectio . The individual postoperative well-being of the women was recorded by visual analog scales . - PATIENTS AND METHODS Women , whom realize the including criteria s ( first caesarean section , > /= 32 . week of pregnancy , one baby ) , were examined in this study over one year : 105 patients operated with the Misgav Ladach method and 67 conventionally operated patients . The patients were r and omized in a function of the first letter of the surname ( A-K  : Misgav-Ladach method ; L-Z : classical technique )  . - RESULTS The surgical time from the cut to the seam was significantly shorter ( 29.8 vs. 49.3 min ; p < 0,001 ) in the Misgav Ladach group . There were no differences between the two methods in the rate of postoperative complications . The febrile morbidity was equivalent in both groups ( 7.6 % vs. 9 % ) , likewise the frequency of postoperative hematomas ( 3.8 % vs. 3 % ) . The postoperative period with consumption of analgetics was significantly longer in the group of conventionally operated patients ( 1.9 d vs. 2.4 d ; p < 0.01 ) . The postoperative presentness was estimated significantly better ( p < 0,.01 ) by the patients of the Misgav ladach group - probably caused by the significantly earlier mobilization ( p < 0.05 ) . - CONCLUSION The surgical technique described by Misgav and Ladach allows a safe execution of the caesarean section and represents an alternative to the conventional method . The duration of operation ( cut-seam-time ) was significantly shorter . The technique of less traumatising of tissue caused a significantly earlier mobilisation and a significantly shorter requirement of analgetics . The women estimated her postoperative physical condition as better The Joel-Cohen incision followed by nonclosure of pelvic and parietal peritoneum has been advocated as an alternative method to the Pfannenstiel incision with peritonealization at cesarean section . A r and omized trial was design ed to compare intra- and postoperative morbidity between the two techniques . Women to undergo a cesarean section were r and omly allocated to have either the Joel-Cohen incision with the parietal and pelvic peritoneum left open ( group 1 ) or to have the Pfannenstiel incision with both peritoneal layers sutured ( group 2 ) . The myometrium was closed with 1 - 0 polyglactin 910 suture using a continuous single-layer nonlocking technique .  Patients in group 2 had the peritoneum approximated with 2 - 0 polyglactin 910 suture . The fascia was sutured with continuous 1 - 0 polyglactin 910 suture in all cases . Opening time was defined as the interval from skin incision to the opening of the uterine cavity . Febrile morbidity was defined as a temperature > or = 38 degrees C on two occasions 4 hours ( hr ) apart excluding the first postoperative day . Endometritis was defined as postpartum temperature > or = 38 degrees C on two occasions 4 hr apart , with uterine tenderness and /or foul-smelling lochia .  One hundred forty-nine and 150 patients were allocated to group 1 and to group 2 , respectively . A shorter median ( range ) opening time [ 4 min ( 2 - 21 ) vs. 6 min ( 2 - 19 ) , respectively , p < 0.01 ] and a shorter median ( range ) operative time [ 30 min ( 10 - 65 ) vs. 40 min ( 20 - 110 ) , respectively , p < 0.01 ] were observed in group 1 . No difference was found in terms of intraoperative complications , proportion of patients who required transfusion , endometritis , sepsis , febrile morbidity , and urinary tract infections . A higher rate of wound infections was found in group 2 than in group 1 [ 14 of 150 ( 9.3 % ) vs. 2 of 149 ( 1.3 % ) , respectively , p < 0.01 ] . The Joel-Cohen incision without peritonealization result ed in a shorter opening and total operative time than the Pfannenstiel laparotomy with peritonealization . This was accomplished with a reduction of wound infections Design CORONIS is a pragmatic multicentre fractional factorial r and omised controlled trial and is being conducted in sites in Argentina , Chile , Ghana , India , Kenya , Pakistan and Sudan [ 1 ] . Women are eligible if they are undergoing their first or second caesarean section through a transverse abdominal incision . Five comparisons will be carried out using a 2 balanced incomplete block factorial design . Each woman is allocated THREE of the five pairs of interventions using a bespoke secure webbased r and omisation system ( with 24/7 automated backup telephone system ) hosted by the NPEU Clinical Trials Unit . The 5 pairs of interventions are : i. Blunt versus sharp abdominal entry ii . Exteriorisation of the uterus for repair versus intraabdominal repair iii . Single versus double layer closure of the uterus iv . Closure versus non-closure of the peritoneum ( pelvic and parietal ) v. Chromic catgut versus Polyglactin-910 for uterine repair Primary outcome : death or maternal infectious morbidity ( one or more of the following : antibiotic use for maternal febrile morbidity during postnatal hospital stay , antibiotic use for endometritis , wound infection or peritonitis ) or further operative procedures or blood transfusion . Sample size required : 15,000 women in total ; minimum 9,000 women per comparison pair In recent years Stark and colleagues ( 1 , 2 ) proposed the application to the  cesarean section  of a number of new surgical techniques adopted from various sources : the differences with respect to the traditional procedures were the Joel-Cohen methods for opening the abdomen , suturing the uterus in one layer , and non-closure of the visceral and parietal peritoneal layers . They demonstrated that this cesarean section procedure is safe , fast and has a low risk of postoperative complications in the mothers ( 2 ) and therefore this technique has been adopted in many centers . Nevertheless , the possible consequences of these changes on the short-term outcome of the newborn have never been evaluated . Cesarean section and maternal anesthesia are risk factors for the respiratory distress syndrome , transient tachypnea and respiratory depression in the newborn infants  ( 3 ) and , therefore , we wanted to evaluate if a cesarean section technique presumably faster than the traditional procedure could improve the short-term outcome of the newborns Background Caesarean section is one of the most commonly performed operations on women throughout the world . Rates have increased in recent years – about 20–25 % in many developed countries . Rates in other parts of the world vary widely . A variety of surgical techniques for all elements of the caesarean section operation are in use . Many have not yet been rigorously evaluated in r and omised controlled trials , and it is not known whether any are associated with better outcomes for women and babies . Because huge numbers of women undergo caesarean section , even small differences in post-operative morbidity rates between techniques could translate into improved health for substantial numbers of women , and significant cost savings . Design CORONIS is a multicentre , fractional , factorial r and omised controlled trial and will be conducted in centres in Argentina , Ghana , India , Kenya , Pakistan and Sudan . Women are eligible if they are undergoing their first or second caesarean section through a transverse abdominal incision .  Five comparisons will be carried out in one trial , using a 2 × 2 × 2 × 2 × 2 fractional factorial design . This design has rarely been used , but is appropriate for the evaluation of several procedures which will be used together in clinical practice . The interventions are : • Blunt versus sharp abdominal entry • Exteriorisation of the uterus for repair versus intra-abdominal repair • Single versus double layer closure of the uterus • Closure versus non-closure of the peritoneum ( pelvic and parietal ) • Chromic catgut versus Polyglactin-910 for uterine repair The primary outcome is death or maternal infectious morbidity ( one or more of the following : antibiotic use for maternal febrile morbidity during postnatal hospital stay , antibiotic use for endometritis , wound infection or peritonitis ) or further operative procedures ; or blood transfusion . The sample size required is 15,000 women in total ; at least 7,586 women in each comparison . Discussion Improvements in health from optimising caesarean section techniques are likely to be more significant in developing countries , because the rates of postoperative morbidity in these countries tend to be higher . More women could therefore benefit from improvements in techniques . Trial registration The CORONIS Trial is registered in the Current Controlled Trials registry . ISCRTN31089967 The ease of execution and the post-operative quality of 2 types of incision commonly performed in pelvic surgery were compared in a prospect i ve r and omised study : Pfannenstiel 's incision was used in 59 patients and Mouchel 's low transverse abdominal incision ( LTA ) in 60 patients . Results were evaluated 8 days and 3 months after the operation . There was no difference in immediate post-operative results between these two groups of patients . At the 3 month examination , hypoaesthesia of the skin was less frequent in patients who had been operated upon through the LTA incision . The authors conclude that the transmuscular incision is innocuous OBJECTIVE To compare the Pfannenstiel incision with transverse muscle‐cutting Maylard incision in women who had cesarean delivery . METHODS Patients were assigned r and omly to a Pfannenstiel or Maylard incision .  Postoperative ttreatment was similar for each group . Surgical characteristics , complications , postoperative pain ( visual analog scale , analgesic use ) , and related quality of life ( 1‐ and 3‐month self‐administered question naires ) were analyzed . Abdominal wall muscle recovery was compared objective ly by dynamometer . RESULTS Fifty‐four women had a Pfannenstiel incision and 43 had the Maylard incision . There were no differences in intraoperative characteristics , postoperative morbidity , or pain . Women 's responses to the Nottingham Health Profile question naire at 1 and 3 months postoperatively and clinical and isokinetic testing for abdominal wall strength were similar between the two groups . CONCLUSION Transecting the rectus muscle was no more deleterious than the Pfannenstiel incision . There was no difference in objective ly measured abdominal wall strength OBJECTIVE The aim of the study was to evaluate the outcome of two different methods of  cesarean section  ( CS ) . DESIGN The study was design ed as a prospect i ve , r and omized , controlled trial . SETTING All CS were performed at the University Hospital in Uppsala , Sweden . POPULATION Fifty women admitted to hospital for a first elective CS were consecutively included in the study . They were r and omly allocated to two groups . METHODS One group was operated on by the Misgav Ladach method for CS and the other group by the Pfannenstiel method . All operations were performed by the same surgeon . MAIN OUTCOME MEASURES Duration of operation , amount of bleeding , analgesics required , scar appearance and length of hospitalization . RESULTS Operating time was significantly different between the two methods , with an average of 12.5 minutes with the Misgav Ladach method and 26 minutes with the Pfannenstiel method ( p<0.001 ) . The amount of blood loss differed significantly , with 448 ml and 608 ml respectively ( p=0.017 ) . Significantly less analgesic injections and tablets ( p=0.004 ) were needed after the Misgav Ladach method . CONCLUSION The Misgav Ladach method of CS has advantages over the Pfannenstiel method by being significantly quicker to perform , with a reduced amount of bleeding and diminished postoperative pain . The women were satisfied with the appearance of their scars . In this study no negative effects of the new operation technique were discovered Cesarean delivery may be complicated by dystocia if the incision size is in 
    Output:
    
The Joel-Cohen incision has advantages compared with the Pfannenstiel incision .
These are : less fever , pain and analgesic requirements ; less blood loss ; shorter duration of surgery and hospital stay .
These advantages for the mother could be extrapolated to savings for the health system .
However , these trials do not provide information on severe or long-term morbidity and mortality