Prospective Study of Non-Closure or Closure of the Peritoneum at Cesarean Delivery in 124 Women: Impact of Prior Peritoneal Closure at Primary Cesarean on the Interval Time Between First Cesarean Section and the Next Pregnancy and Significant Adhesion at Second Cesarean

Komoto, Yoshiko; Shimoya, Koichiro; Shimizu, Takasi; Kimura, Tadashi; Hayashi, Satoru; Temma-Asano, Kumiko; Kanagawa, Takeshi; Fukuda, Hirotsugu; Murata, Yuji

doi:10.1097/01.ogx.0000251099.76370.1b

Cited by 11 publications

(16 citation statements)

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“…Whereas some groups found that closure of the peritoneum helps prevent future adhesion formation, [35][36][37] others proposed that closure of the peritoneum significantly increased the incidence of adhesion formation. 38 Komoto et al compared the adhesion development in 124 patients who had peritoneum closure and nonclosure in prior cesarean sections during their repeat cesarean sections. A total of 63 patients were reoperated and evaluated for adhesion development in their second cesarean sections.…”

Section: Peritoneal Closure Versus Nonclosurementioning

confidence: 99%

Postoperative Adhesions: From Formation to Prevention

2008

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Postoperative intra-abdominal and pelvic adhesions are the leading cause of infertility, chronic pelvic pain, and intestinal obstruction. It is generally considered that some people are more prone to develop postoperative adhesions than are others. Unfortunately, there is no available marker to predict the occurrence or the extent and severity of adhesions preoperatively. Ischemia has been thought to be the most important insult that leads to adhesion development. Furthermore, a deficient, suppressed, or overwhelmed natural immune system has been proposed as an underlying mechanism in adhesion development. The type of surgical approach (laparoscopy or laparotomy) and closure of peritoneum in gynecologic surgeries and cesarean section have been debated as important factors that influence the development and extent of postoperative adhesions. In this article, we have reviewed the current state of adhesion development and the effects of barrier agents in prevention of postoperative adhesions.

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Section: Peritoneal Closure Versus Nonclosurementioning

confidence: 99%

Postoperative Adhesions: From Formation to Prevention

2008

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“…Estudios previos han informado resultados similares a la presente investigación en los que no encontraron diferencias significativas en las diferentes variables intra-y post-operatorias en las pacientes que se realizó o no la peritonización 15 . Sin embargo, otros estudios al igual que este, han reportado una duración de la cirugía menor cunado no se cierra el peritoneo 16 .…”

Section: Discussionunclassified

“…La mayoría de los investigadores no han demostrado diferencias significativas entre los grupos de cierre o no del peritoneo con respecto a la morbilidad infecciosa. Varios estudios no han demostrado diferencias en la frecuencia de fiebre post-operatoria, endometritis o infección de la herida quirúrgica 15,16,20 . Contrario a lo previamente expuesto, otras dos investigaciones encontraron disminución significativa en la frecuencia de morbilidad febril en las pacientes que no se realizó la peritonización, sin diferencias en la incidencia de endometritis o infección del tracto urinario 23,26 .…”

Section: Discussionunclassified

Resultante Materna a Corto Plazo Del Cierre O No Del Peritoneo Durante La Cesárea.

Mejia-Montilla

Reyna-Villasmil

Torres-Cepeda

et al. 2019

Rev. chil. obstet. ginecol.

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RESUMENOBJETIVO: Comparar la resultante materna a corto plazo del cierre o no del peritoneo durante la cesárea. MÉTODOS: Se realizó un estudio al azar, doble ciego y controlado en embarazadas que asistieron al Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. Las pacientes seleccionadas se asignaron al azar al grupo A (grupo no intervenido, cirugía sin cierre peritoneal) y Grupo B (grupo intervenido, cirugía con cierre peritoneal). Se evaluaron características generales, duración de la cirugía, concentraciones de hemoglobina posterior a la cirugía, duración de la hospitalización, dolor post-operatorio, necesidad de analgesia de rescate y frecuencia de complicaciones post-operatorias. RESULTADOS: Se seleccionaron para el análisis final 247 pacientes en el grupo A y 248 pacientes en el grupo B. Se observó que las pacientes del grupo A presentaban duración de la cirugía significativamente menor comparado con las pacientes del grupo B (p < 0,0001). No se observaron diferencias en valores de hemoglobina post-operatoria, tiempo de hospitalización, intensidad de dolor postoperatorio, aparición de ruidos hidroaéreos y complicaciones post-operatorias (p = ns). CONCLUSIÓN: No realizar la peritonización no parece tener efectos negativos sobre la resultante materna a corto plazo en comparación con los casos en las que si se realiza.ABSTRACT OBJECTIVE: To compare short-term maternal outcome of the closure or not of peritoneum during cesarean section. METHODS: A randomized, double-blind and controlled study was conducted on pregnant women who attended at Hospital Central "Dr. Urquinaona", Maracaibo, Venezuela. The selected patients were randomly assigned to group A (non-intervened group, surgery without peritoneal closure) and group B (intervened group, surgery with peritoneal closure). General characteristics, duration of surgery, hemoglobin concentrations after surgery, duration of hospitalization, post-operative pain, need for rescue analgesia and frequency of postoperative complications was evaluated. RESULTS: A total of 247 patients in group A and 248 patients in group B were selected for the final analysis. It was observed that patients in group A had a significantly shorter duration of surgery compared to patients in group B (p <0.0001). No differences were observed in postoperative hemoglobin values, hospitalization time, postoperative pain intensity, return of bowel movements and postoperative complications (p = ns). CONCLUSION: To not perform peritonization does not appear to have negative effects on the short-term maternal outcome compared with cases which it is done.

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“…Several studies have found that leaving the peritoneum intact has better results than other methods, for instance, Komoto found that suturing the peritoneum is unnecessary 9 . However, in another study by Deidre et al, the authors showed that suturing peritoneum can lower filmy and dense types of adhesion.…”

Section: Discussionmentioning

confidence: 99%