DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20212646

A prospective randomized controlled study comparing short-term outcomes of closure and non-closure of peritoneum during elective caesarean section

Santoshi Prabhu, Deepti N. Prasad, Nigamanand Mishra, Vaishali Jadhav, Gayatri Savani

Abstract


Background: There is a rising trend of caesarean deliveries worldwide. Although a very commonly performed abdominal surgery, there is no ideal operative procedure in the literature. Several studies compared short term and long-term outcomes of closure and non-closure of peritoneum, but there is no consensus whether either procedure is beneficial to patients. Variability of results may be due to bias involved in these studies as two groups compared had different characteristics (including obstetrics and non-obstetrics laparotomies, elective and emergency caesareans, Pfannenstiel as well as vertical incisions; in the same study) which are likely to affect short term outcomes besides those due to peritoneal closer and non-closure. Aims and objectives of the study were to perform an unbiased assessment of short-term outcomes in elective LSCS in unscarred abdomens by Pfannenstiel incisions between closure (CG) and non-closure of peritoneum (NCG).

Methods: Prospective randomised controlled study method used in the study.

Results: The operating time was significantly more (p=0.01) with difference of additional 10 minutes in CG with standard error of mean for time being 3.7688. Pain score was more in CG on post-operative day 1 and 2 (p=0.0003 and 0.008 respectively). Additional anaesthesia and analgesia were not needed in this group.

Conclusions: Apart from operative timing and pain score in early post-op period, there was no significant difference in short term outcomes between CG and NCG during elective caesarean section. Hence only long-term effects of these procedures need to be considered prior to recommending ideal steps of elective caesarean section procedure.


Keywords


Visual analogue scale, Non-closure, Peritoneum, Caesarean section

Full Text:

PDF

References


Hauth JC, Owen J, Davis RO. Transverse uterine incision closure. One versus two layers. Am J Obstet Gynecol. 1992;167:1108-11.

Kerr JMM. The technic of Cesarean section, with special reference to the lower uterine segment incision. Am J Obstet Gynecol. 1926;12:729-34.

Huchon C, Raiffort C, Chis C, Messaoudi F, Jacquemot MC, Panel P. Caesarean section: closure or non-closure of peritoneum? A randomized trial of postoperative morbidity. Gynecol Obstet Fertil. 2005;33(10):745-9.

Bamigboye AA, Hofmeyr GJ. Non-closure of peritoneal surfaces at caesarean section-a systematic review. S Afr Med J. 2005;95(2):123-6.

Cheong YC, Bajekal N, Li TC. Peritoneal closure to close or not to close. Hum Reprod. 2001;16(8):1548-52.

Tabasi Z, Mahdian M, Abedzadeh-Kalahroudi M. Closure or Non-Closure of Peritoneum in Cesarean Section: Outcomes of Short-Term Complications. Arch Trauma Res. 2013;1(4):176-9.

Nagele F, Karas H, Spitzer D, Staudach Al, Karasegh S, Beck A et al. Closure or non-closure of the visceral peritoneum at cesarean delivery. American J Obst Gyn. 1996;174(4):1366-70.

Bamigboye AA, Hofmeyr GJ. Closure versus non closure of the peritoneum at caesarean section: short- and long-term outcome. Cochrane Database Syst Rev. 2014;11;(8):CD000163.

Cheong YC, Premkumar G, Metwally M, Peacock JL, Li TC. To close or not to close? A systematic review and a meta-analysis of peritoneal nonclosure and adhesion formation after caesarean section. Eur J Obstet Gynecol Reprod Biol. 2009;147(1):3-8.

Al-Asmari N, Tulandi T. The relevance of post-cesarean adhesions. Surg Technol Int. 2012;22:177-81.

Choudhary A, Bansal N. Non closure of parietal peritoneum at cesarean section and adhesion formation. Int J Reprod Contracept Obstet Gynecol. 2013;2:406-9.

Lyell DJ, Chaughey AB, Hu E, Daniels K. Peritoneal closure at primary cesarean delivery and adhesions. Obstet Gynecol. 2005;106(2):275-80.