Objective: To assess the rate of adhesions and other long-term outcomes of two cesarean delivery techniques.

Methods: A total of 600 women were randomly assigned to either a standard (Pfannenstiel-Kerr) or modified (Joel-Cohen-Stark) technique for first-time cesarean delivery. A total of 124 women were assessed at repeat cesarean delivery. The primary outcome measure was the presence of adhesions.

Results: At repeat cesarean delivery, anesthesia-to-delivery time, total duration of surgery, change in hemoglobin level, time to mobilization and oral intake, and postoperative hospital stay were significantly less with the modified technique. Adhesions were found in 7 (11.3%) and 22 (35.5%) of the cases using the modified and standard techniques, respectively (P=0.0026; relative risk 3.14 [95% CI, 1.45-6.82]).

Conclusion: A modified cesarean delivery technique, including Joel-Cohen incision, exteriorized full thickness suturing of the uterine incision, and non-closure of the peritoneum may reduce long-term morbidities of the procedure.