Uvod: carski rez (CR) je najčešća operacija kod žena u reproduktivnom dobu. Zbog svoje učestalosti, svaki uticaj CR na zdravlje žene ima veliki klinički, ekonomski i društveni značaj. Hronične komplikacije CR postaju značajan deo morbiditeta pacijentkinja posle CR. Osnova za njihov nastanak je niša u ožiljku od CR. Istraživanja su usmerena na prepoznavanje elemenata operativne tehnike kojima bi moglo da se utiče na učestalost i veličinu niše. Ciljevi: uporediti učestalost hroničnih komplikacija CR (rupture materice - RM, dehiscencije ožiljka - DO i histerektomije zbog placenta akreta spektra - PAS) i karakteristike ožiljaka na materici između tehnika histerorafije koje se primenjuju na Klinici za ginekologiju i akušerstvo Univerzitetskog kliničkog centra Vojvodine (UKCV). Materijal i metode: retrospektivnim segmentom je analizirana serija slučajeva RM, DO i PAS i ispitana učestalost u odnosu na tehniku histerorafije za period 2008-2022. godine. Prospektivnim segmentom je analizirana debljina ožiljka, kao i histološka građa 147 uzoraka ožiljka materice koji su bili podeljeni u tri grupe u odnosu na tehniku histerorafije na prethodnom carskom rezu:grupa A – histerorafija modifikovanom tehnikom po Vejnoviću; grupa B – jednoslojno šivenje sa zaključavanjem; grupa C – dvoslojno šivenje. Merenja i prikupljanje uzorka je vršeno intraoperativno, kod pacijentkinja koje su imale jedan prethodni carski rez. Histološka analiza je obuhvatala zastupljenost fibroze, mišićnog tkiva i proliferacije. Nalazi se upoređeni u odnosu na grupu tehnike histerorafije. Rezultati: RM je zabeležena u 30/243 slučaja (3.56/10.000 porođaja, 1.15/1000 CR). DO je zabeležena u 208/243 (2.47/1000 porođaja, 7.99/1000 CR). Zabeležen je 51 slučaj PAS (5.22/10.000 porođaja, 1.64/1.000 CR). Zastupljenost tehnike A među komplikacijama je bila manja nego grupe B i C (DO grupa A 11.1%, grupa B 83.3% grupa C 33.3%; PAS: grupa A 15.4%, grupa B 61.5%, grupa C 53.8%). Kod pacijentkinja koje su imale peripartalnu histerotomiju zbog PAS nije pronađen nijedan slučaj kod koga su svi prethodni CR rađeni tehnikom iz grupe A. Debljina ožiljka je bila značajno veća u grupi A u odnosu na grupu B i grupu C (5.45±2.19mm vs. 3.65±1.69mm vs. 3.73±1.45mm; p<0.001). Nije bilo statistički značajne razlike u zastupljenosti fibroze, mišićnog tkiva i proliferacije između ispitivanih grupa. Zaključci: postoje razlike u debljini ožiljka i učestalosti RM i PAS između različitih tehnika histerofije zastupljenih na UKCV. Posle histerorafije modifikovanom tehnikom po Vejnoviću javlja se deblji ožiljak i manja učestalost komplikacija. Razlika u zarastanju materice između tehnika se manifestuje debljinom ožiljka, a ne razlikom u histološkoj građi.Introduction: cesarean section (CS) is the most common operation in women of reproductive age. Because of its frequency, any impact of CS on women's health has great clinical, economic and social significance. Chronic complications of CS become a significant part of patient morbidity after CS. The basis for their occurence is a niche in the CS scar. Research is focused on identifying elements of operational technique that could influence the frequency and size of the niche. Objectives: to compare the frequency of chronic complications of CS (uterine rupture - RM, scar dehiscence - SD and hysterectomy due to placenta accreta spectrum - PAS) and the characteristics of the uterine scar between uterine closure techniques applied at the Clinic for Gynecology and Obstetrics of the University Clinical Center of Vojvodina (UKCV). Material and Мethods: a series of cases of RM, SD and PAS were analyzed in a retrospective segment and the frequency was examined in relation to the uterine closure technique for the period 2008-2022. The prospective segment analyzed the thickness of the scar, as well as the histological structure of 147 samples of the uterine scar, which were divided into three groups in relation to the uterine closure technique on the previous cesarean section: group A – uterine closure by Vejnović modification; group B – single- layer, continuous locking uterine suturing; group C – double-layer uterine closure. Measurements and sample collection were performed intraoperatively, in patients who had one previous cesarean section. The histological analysis included the representation of fibrosis, muscle tissue and proliferation and the findings were compared in relation to the uterine closure technique. Results: RM was recorded in 30/243 cases (3.56/10,000 births, 1.15/1000 CS). SD was recorded in 208/243 (2.47/1000 births, 7.99/1000 CS). There were 51 cases of PAS (5.22/10,000 births, 1.64/1,000 CS). The representation in complications of group A was lower compared to groups B and C (SD: group A 11.1%, group B 83.3% group C 33.3%; PAS group A 15.4%, group B 61.3% group C 53.8%). In patients who had peripartum hysterectomy due to PAS, no cases were found in which all previous CSs were performed using the technique of group A. The thickness of the scar was significantly greater in group A compared to group B and group C (5.45±2.19 mm vs. 3.65 ±1.69mm vs. 3.73±1.45mm; p<0.001). There was no statistically significant difference in the representation of fibrosis, muscle tissue and proliferation between the examined groups. Conclusions: there are differences in scar thickness and frequency of RM and PAS among different uterine closure techniques. After Vejnović modified technique, a thicker scar occurs and the frequency of complications is lower. The difference in the healing of the uterus among the techniques is manifested by the thickness of the scar, rather than the difference in the histological structure
