It is standard practice to close the peritoneum following cesarean section in order to restore normal anatomy, reapproximate tissues, and lessen the possibilities of wound dehiscence, hemorrhage, and adhesion formation. Controlled studies of gynecologic surgeries have, however, established no detrimental effects when the peritoneum is not closed, and there is some indication of less short-term postoperative morbidity. Cost savings could be substantial were nonclosure found to be safe or even beneficial in connection with cesarean delivery. This controlled study examined the effects of closing versus not closing the visceral and parietal peritoneum in 124 women who were to have cesarean section. Seventy of them, the C group, did have the peritoneum closed, while the remaining 54 comprised a nonclosure (NC) group. Neither the visceral nor the parietal peritoneum was closed in the NC group.
There were no significant group differences in patient characteristics or the indications for cesarean delivery. Sixty-three women, 35 in the C group and 28 in the NC group, returned for a subsequent delivery. Postoperative complications including fever, anemia, wound infection, endometritis, urinary tract infection, pneumonia, and ileus, were comparably frequent in the C and NC groups. Women who underwent closure used significantly more postoperative analgesia, and mean total operating time was significantly longer in the C group. The interval from section delivery to the next pregnancy was significantly shorter in the NC group. At repeat section, mean total operating time and the mean interval from skin incision to delivery were significantly longer in the C group. Adhesions were significantly more frequent in the C group. Severe adhesions requiring adhesiolysis before uterine incision were present in six women in the C group and none in the NC group.
These results, showing that closing the peritoneum at primary cesarean section promotes adhesion formation, led the investigators to strongly recommend that the peritoneum not be closed at operative delivery.
Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka; and Shimizu Women's Clinic, Minamiguchi, Takarazuka, Japan
J Obstet Gynaecol 2006;32:396–402