Closure versus non-closure of the peritoneum at caesarean section: short- and long-term outcomes

Abstract

Background Caesarean section is a very common surgical procedure worldwide. Suturing the peritoneal layers at caesarean section may or may not confer benefit, hence the need to evaluate whether this step should be omitted or routinely performed. Objectives The objective of this review was to assess the effects of non-closure as an alternative to closure of the peritoneum at caesarean section on intraoperative and immediate- and long-term postoperative outcomes. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (1 November 2013). Selection criteria Randomised controlled trials comparing leaving the visceral or parietal peritoneum, or both, unsutured at caesarean section with a technique which involves suturing the peritoneum in women undergoing elective or emergency caesarean section. Data collection and analysis Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked it for accuracy. Main results A total of 29 trials were included in this review and 21 trials (17,276 women) provided data that could be included in an analysis. The quality of the trials was variable. 1. Non-closure of visceral and parietal peritoneum versus closure of both parietal layers Sixteen trials involving 15,480 women, were included and analysed, when both parietal peritoneum was left unclosed versus when both peritoneal surfaces were closed. Postoperative adhesion formation was assessed in only four trials with 282 women, and no difference was found between groups (risk ratio (RR) 0.99, 95% confidence interval (CI) 0.76 to 1.29). There was significant reduction in the operative time (mean difference (MD) -5.81 minutes, 95% CI -7.68 to -3.93). The duration of hospital stay in a total of 13 trials involving 14,906 women, was also reduced (MD -0.26, 95% CI -0.47 to -0.05) days. In a trial involving 112 women, reduced chronic pelvic pain was found in the peritoneal non-closure group. 2. Non-closure of visceral peritoneum only versus closure of both peritoneal surfaces Three trials involving 889 women were analysed. There was an increase in adhesion formation (two trials involving 157 women, RR 2.49, 95% CI 1.49 to 4.16) which was limited to one trial with high risk of bias.There was reduction in operative time, postoperative days in hospital and wound infection. There was no significant reduction in postoperative pyrexia. 3. Non-closure of parietal peritoneum only versus closure of both peritoneal layers The two identified trials involved 573 women. Neither study reported on postoperative adhesion formation. There was reduction in operative time and postoperative pain with no difference in the incidence of postoperative pyrexia, endometritis, postoperative duration of hospital stay and wound infection. In only one...

The comparing of the operation time of second cesarean section with the closure or non-closure of parietal peritoneum in the first cesarean section: Result in omental adhesions to the scarpa fascia?

“…All policies, for the encouraging patients and doctors for the vaginal deliveries are not enough to decrease the numbers of unneccesary caeserean sections in the world. In 2008, 3.18 million additional cesarean section were needed and 6.20 million unneccesary cesarean section were done [1][2][3]. On the other hand, the cost of global excess cesarean section was estimated to be 2.32 billion US dolars with the cost of global needed cesarean section about 432 million US dolars [1].…”

“…When C-section rates rise towards 10% across a population, maternal and newborn deaths decrease; when they are higher than 15% , there is no evidence of reduced morbidity [6]. Even though, the C-section rates rise up 70% in some countries, the standard evidence-based quidelines are not established [3,2]. The C-section can be repeated operations for same women.…”

“…In 1989, general rate of C/S was around 5% to 20% of all deliveries [7]. In addition to higher C-section rates, there are many possible ways of performing a C-section and operative technique [2]. All surgeon generally use their own or their preference operator procedures.…”

“…In gynecologic operations, the closing of the peritoneum is a standard procedure [2] but it is not in a C-section operation because the closing of peritoneum has some disadvantages in repeatetion of operations. .…”

“…The peritoneum is a thin membrane made of primitive cells called mesothelium and supported by a thin layer of connective tissue [2]. It covers abdominal and pelvic cavity that is called parietal peritoneum and covers external surface of internal organs which is termed visceral peritoneum [2]. During the C-section both layers of peritoneum is incised and the question on that point is both layers should be closed or not.…”