Background: The FAUCS technique has been proposed as an alternative cesarean section approach potentially associated with improved postoperative recovery. Objective: To compare postoperative pain characteristics, functional recovery, analgesic requirements, and psychological outcomes between women undergoing intraperitoneal cesarean section (CS) and FAUCS cesarean section. Methods: A total of 201 women were included in this prospective single-center observational cohort study (CS: n = 101; FAUCS: n = 100). Postoperative pain intensity was assessed using the Numerical Rating Scale (NRS) and the McGill Pain Questionnaire. Functional recovery, emotional status, analgesic intake, and anxiety levels were evaluated during the early postoperative period. Results: FAUCS was associated with significantly lower pain intensity on postoperative day 0 (adjusted β = −1.97, 95% CI −2.63 to −1.32; p < 0.001), lower total McGill Pain Questionnaire scores (adjusted β = −2.85, 95% CI −4.68 to −1.02; p = 0.002), and lower sensory McGill scores (adjusted β = −2.59, 95% CI −4.31 to −0.86; p = 0.003). Time to first sitting and standing was approximately 10 h shorter following FAUCS (both p < 0.001). FAUCS was also associated with lower anxiety levels, better functional independence and overall well-being, and substantially lower weak opioid use (adjusted RR = 0.11, 95% CI 0.03–0.45; p = 0.002). Conclusions: FAUCS was associated with improved early postoperative functional recovery, lower pain burden, lower anxiety levels, and better overall well-being compared with intraperitoneal cesarean section. These findings should be interpreted in the context of the observational, non-randomized study design.

Background: This systematic review aimed to evaluate the safety and outcomes of extraperitoneal cesarean section (EPCS), including the French Ambulatory Cesarean Section (FAUCS), by comparing them to those of transperitoneal cesarean section (TCS). Data Sources: The search was conducted using the following electronic bibliographic databases: PubMed, Web of Science, and Scopus. Studies were included if they were observational or interventional and investigated EPCS, including FAUCS, as the primary intervention. Exclusion criteria were animal studies, reviews, editorials, and conference abstracts. Methods: Two reviewers independently assessed the risk of bias using RoB 2 for RCTs and ROBINS-I for retrospective studies. Studies were grouped into comparable categories, and data were synthesized in summary tables and by comparative descriptive analysis. Results: In comparative studies, EPCS was associated with significantly lower rates of postoperative complications, such as fever (4% vs. 16% for TCS) and elevated C-reactive protein or leukocytosis (0% vs. 16–20%). EPCS reduced postoperative pain, with lower VAS scores at 24 h (e.g., 2.5 vs. 4.0 in TCS, p < 0.001) and shorter analgesic use. Time to return of bowel function was faster in EPCS and modified EPCS (6–8 h vs. 18–24 h in TCS, p < 0.01). Hospital stays were shorter after EPCS (4.15 ± 0.89 days vs. 4.82 ± 1.34 days, p = 0.027). FAUCS enabled early discharge within 24–48 h in 86–93% of cases and reduced morphine use (0.8% vs. 38% in TCS). Neonatal outcomes, including Apgar scores and cord pH, were similar across all groups. Conclusions: EPCS offers several potential advantages over TCS, including less postoperative pain, faster recovery, and shorter hospital stays. EPCS and its FAUCS variant are also associated with quicker return of bowel function and lower analgesic needs. TCS, while enabling faster fetal delivery, is linked to greater postoperative discomfort and slower recovery. However, current evidence is limited, and further high-quality trials are needed to confirm these benefits and assess long-term outcomes.