Laparoscopic Management of Adhesions Developed after Peritoneal Nonclosure in Primary Cesarean Section Delivery

Abstract

Objective The aim of the current study was to laparoscopically investigate the effects of peritoneal nonclosure on the sites, types, and degrees of adhesions developed after primary caesarean section (CS) in women complaining of secondary infertility after first CS delivery. Study Design This was a cross-sectional study, where 250 women suffering from secondary infertility after their first CS had been recruited. They had been classified into group I (n = 89), where both the visceral and parietal peritoneum had been left opened; group II (n = 75), where only the parietal peritoneum had been closed; and group III (n = 86), where both peritoneal layers had been closed. Laparoscopy had been used to classify those adhesions according to the location, severity, and their adverse impact on the reproductive capacity. Results Both adnexal and nonadnexal adhesions had been found significantly higher in group I, while adnexal types of adhesions were significantly higher after nonclosure of the visceral peritoneum in group II. Laparoscopic tubal surgery performed included tubo-ovariolysis, fimbrioplasty, and neosalpingostomy. Pregnancy rate was found correlating with the adnexal adhesion location and score. Conclusion Nonclosure of the peritoneum in CS is associated with more adhesion formation, which might adversely affect the future women reproduction.

Pathogenesis of peritoneal drain complications; a case report of evolving adnexal evisceration following difficult retrieval of a retained peritoneal drain

“…Successful laparoscopic retrieval of retained whole and fractured peritoneal drains after appendicectomy has been reported (21). The laparoscopic approach has been applied successfully for a broad range of cesarean section complications such as abscess drainage, pelvic adhesiolysis, and repair of isthmocoele (9,10,11). Laparoscopy is less invasive and provides an opportunity to retrieve the drainage tube under direct vision to prevent further complications of retrieval as observed in this case.…”

“…It does not add to the duration of hospital stay and would not increase the risk of further drain placement from iatrogenic laparotomy injuries. The risk of postoperative infection is also less (9,10,21).…”

“…Successful laparoscopic management of cesarean section complications has also been well documented (9,10,11). We present here a 32-year-old para 1, who had laparoscopic retrieval of an entrapped post-cesarean section (CS) peritoneal drain, together with detection of an evolving iatrogenic second complication.…”

Association between characteristics of previous cesarean delivery and pelvic adhesions: a case-controlled study

“…On the other side, our results are opposite to Takreem et al who observed that adhesions were less following peritoneal non-closure. In addition, non-closure of peritoneum reduced operative time and anesthesia duration and led to early hospital discharge [24][25][26].…”

Laparoscopic Assessment of the Tubo Ovarian Relationship in Unexplained Infertility

“…As a result, tubal fimbriae do not reach the pelvic floor and so do not pick up eggs. In cases of secondary infertility, tubal abnormalities can occur as a result of post-abortive or puerperal infections [16].…”