0:00:00.776,0:00:08.755
Now we have reached the stage of closing the abdomen

0:00:08.755,0:00:11.786
we don't close the p pereotneum

0:00:11.786,0:00:15.092
which heals by itself in a few days

0:00:15.092,0:00:25.435
in some cases you will see that some surgeons will approximate the rectus abdominus muscle

0:00:25.435,0:00:28.937
but that not also necessary

0:00:28.937,0:00:33.508
as you can see now the first step of closing the abdomen is closing the rectus sheath

0:00:33.508,0:00:37.064
so the rectus sheath or the fascia will be closed by usually

0:00:37.064,0:00:40.349
Vicryl

0:00:40.349,0:00:47.190
and the first step would be to start from the angles and we are going to suture

0:00:47.190,0:00:52.795
it in a continuous nonlocking sutures

0:00:52.795,0:00:58.248
and when we are closing the fascia is to make sure is that

0:00:58.248,0:01:09.423
the firstly that the knot we use at the first site where we are going to do the knot at the angle should be

0:01:09.423,0:01:16.431
locked very well, and the knot should be tight and locked at least four to five times

0:01:16.431,0:01:23.519
and then when we are doing the continuous suture we should at least in each margin

0:01:23.519,0:01:32.694
go inside 1.5 cm inside the rectus sheath so that we avoid any risk

0:01:32.694,0:01:39.443
of tearing of the surture and subsequent dehiscence of the wound

0:01:39.443,0:01:49.253
so we should make sure we should grasp enough of the rectus sheathh at least 1.5 cm from the margin of the wound

0:01:49.253,0:03:06.062
while we are doing the continuous suture

0:03:06.062,0:03:10.833
so once we reach the other end of the wound we should make sure just like we did

0:03:10.833,0:03:14.972
at the closure of the facia at the first end

0:03:14.972,0:03:25.316
we should make sure the knot is strong and the knot is repeated at least four or five times

0:03:25.316,0:03:30.753
and then the next step after we are finished with this

0:03:30.753,0:03:36.324
we should make sure there are no bleeders inside the subcutaneous fat

0:03:36.324,0:03:43.099
and occasionally if it is a very deep subcutaneous fat we may do a some

0:03:43.099,0:03:55.173
interrupted stitch in the subcutaneous fat to avoid a big dead space that could result in subsequent infection

0:03:55.173,0:04:02.548
but if it is not a deep one then we don't need to put any stitches in the subcutaneous fat

0:04:02.548,0:04:05.305
and then in the final stage of the procedure

0:04:05.305,0:04:08.403
is closing the skin

0:04:08.403,0:04:11.057
so the skin would be usually closed by a

0:04:11.057,0:04:16.561
subcuticular stitch that you can see now

0:04:16.561,0:04:23.154
using a 2 O or a 3 O stitch

0:04:23.154,0:06:09.257
it will be a subcuticular continuous stitch that we are going to apply

0:06:09.257,0:06:13.879
So after we are done with the closure of the skin

0:06:13.879,0:06:16.427
before we dress the wound we have to clean it

0:06:16.427,0:06:26.059
again with some povodone iodine then we put a sterile dressing

0:06:26.059,0:06:30.497
and tape the wound

0:06:30.497,0:06:33.565
and after we are done with this

0:06:33.565,0:06:36.904
we also have to check and clean the vagina

0:06:36.904,0:06:40.693
of the woman for any clots, accumulating clots

0:06:40.693,0:06:44.693
so we'd have to do this with assistance