Classical versus double knots facia closure method during cesarean section; is there a difference in pain sensation or cosmetic satisfaction?

Aim: This study aimed to compare two rectus fascia closure techniques used during cesarean section and to evaluate their effects on postoperative pain, analgesic requirement, and cosmetic satisfaction. Methods: A prospective observational study was conducted including 218 women undergoing cesarean delivery. Participants were allocated into two groups according to the fascia closure method. In the classical continuous technique (Group 1), the fascial edges were grasped with a Kocher clamp and closed with a synthetic absorbable multifilament suture using a single-line knot. In the double-knot technique (Group 2), the fascia was closed with the same suture material beginning from the opposite direction, creating an additional loop, and the two sutures were tied together. Pain was assessed on postoperative days 1 and 10 using the Numeric Rating Scale (NRS). Analgesic consumption during hospitalization was recorded. Cosmetic satisfaction regarding the surgical incision was evaluated using a 10-point scale at 1 and 3 months after surgery. Results: Baseline demographic and clinical characteristics were comparable between the groups. Postoperative day-1 and day-10 NRS pain scores did not differ significantly (p>0.05). However, Group 1 required higher amounts of analgesics compared with Group 2 (NSAIDs: 2.6±1.2 vs. 1.7±0.8; paracetamol: 1.1±0.8 vs. 0.8±0.7; p