Background: Simplifying cesarean section (CS) by omitting non-essential steps, such as bladder flap (BF) formation, is increasingly explored to optimize outcomes. Historically, BF was used to prevent bladder injury and infection, but recent evidence questions its necessity, linking it to prolonged operative time, adhesions, and complications. This updated review evaluates whether omitting BF improves CS outcomes.

Objective: to evaluate whether omitting bladder flap formation during cesarean sections improves clinical outcomes compared to standard cesarean sections with bladder flap creation.

Methods: We searched PubMed, Scopus, Web of Science, and Cochrane without filters,
  including RCTs comparing BF versus no BF (NBF) in pregnant women undergoing CS.
  Outcomes included operative time, blood loss, bladder injury, postoperative pain, urinary
  symptoms, and hospital stay. Statistical analysis used RevMan 5.4.1, employing a random-effects model to calculate mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CI). Heterogeneity was assessed using I² and Chi² tests, with sensitivity analyses to ensure robustness.