The Stark (Misgav Ladach) cesarean delivery-a streamlined surgical technique: development, rationale, and clinical outcomes

Abstract

Cesarean delivery rates rise globally, yet the procedure remains unstandardized. Wide variation in abdominal and uterine incisions, peritoneal handling, and closure techniques hinders meaningful comparisons of outcomes, operation time, blood loss, postoperative pain, adhesion formation, and uterine scar integrity. To enable a needed unified method which will enable comparison among surgeons and hospitals, a simplified surgical approach was developed at Misgav Ladach Hospital (Jerusalem, Israel) through critical evaluation of each operative step. Only essential ones were retained and optimized, resulting in what is now termed the Stark (Misgav Ladach) cesarean technique. Over 30 years of implementation, both in low- and high-resource settings, hs demonstrated superior outcomes compared with conventional methods. These include shorter skin-to-delivery time, lower febrile morbidity, less blood loss, fewer adhesions, and decreased need for analgesics.

Keywords: Joel-Cohen; Pfannenstiel; birth; blunt dissection; laparotomy; minimally invasive surgery; peritoneum; stark cesarean; surgery.