METHODS: A double-blinded randomised controlled trial comparing the aesthetic outcome between tissue adhesive and conventional suture was conducted among patients undergoing thyroid and parathyroid surgeries. Ninety-six patients were randomised into two treatment groups. Patients' wounds were scored by an independent observer using the SBSES score at 6 weeks postoperatively and observer component of the POSAS score at 3 months.

PRESENTATION OF CASE: A 30-year-old woman, who had a previous cesarean delivery, opted for another cesarean section (CS) during this pregnancy. She claimed that her tummy was lax after her first experience of CS even with regular exercise. A standard CS procedure was carried out along with the new modified undermined suture technique for rectus muscle re-approximation. Post-operatively, the pain score was 2/10 without any evidence of hematoma, seromas or infection and the patient ambulates well. The patient did not complain of any pain or complications upon follow up after 2 weeks and 2 months post-operation. She claims that her abdomen is firmer, flatter and more stable compared to her previous operation experience.

DISCUSSION: This newly modified method prevents any defect or weakness on the anterior abdominal wall even if the rectus muscles fail to oppose itself during the healing process. It also mimics the function of the linea alba and avoid interrupting the contraction or injuring the muscle in order to avoid pain. Adhesion of the anterior uterine wall and the rectus sheath can be prevented by closure of the rectus muscle and burying the suture material within the muscle.