The Iranian Journal of Obstetrics, Gynecology and Infertility

The Iranian Journal of Obstetrics, Gynecology and Infertility

Comparison of Outcomes between Closure versus Non-Closure Visceral and Parietal Peritoneum during Cesarean Section: A Randomized Clinical Trial

Document Type : Original Article

Authors
sanam moradan 1
Raheb Ghorbani 2
Marzieh Eslami 3
1 Associate Professor, Department of Obstetrics and Gynecology, Research Center of Abnormal Uterine Bleeding, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran.
2 Associate Professor, Department of Community Medicine, Research Center for Social Determinants of Health, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran.
3 Resident of Obstetrics and Gynecology, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran.
10.22038/ijogi.2014.2593
Abstract
Introduction: There are many techniques for cesarean sections that each of them has different outcomes. Some clinicians advocate close and some advocate open the visceral and parietal peritoneum. There was different idea about this subject and decided to compare some short term outcomes of two different techniques, closure versus non closure visceral and parietal peritoneum during cesarean section.
Methods: This randomized double- blind controlled trial was conducted on 80 term pregnant women who underwent for first elective cesarean section in Amir-Almomenin hospital in semnan, Iran from October 2011 to December 2012. Patients were randomly divided into two groups. In one group parietal and visceral peritoneum were closed (control group) and in second group both layers were left open (study group). All cases underwent cesarean section with spinal anesthesia and the surgery was performed by the same surgeon. The severity of pain was measured over the first 24 hours after operation by visual analogous scale and the dosage of analgesic use, the bowel transit time and wound infection during first week after operation were assessed and compared in both groups. Data were analyzed using SPSS software version 16 and chi-square, Mann-Whitney, Wilkinson, t-test and repeated measures ANOVA tests. P value less than 0.05 was considered significant.
Results: The pain score (p<0.001), the mean usage of analgesic over 24 hours (p=0.012) and bowel transit time (p= 0.001) in non-closure group was significantly less than closure group. But wound infection was similar in both groups(p= 1).
Conclusion: The technique of non-closure of peritoneums has some short term postpartum benefits such as less post operation pain, less amount of analgesic use and more rapid bowel transit time.
Keywords
Cesarean section
Outcome
Peritoneum
  1. Duffy DM, diZerega GS. Is peritoneal closure necessary? Obstet Gynecol Surv 1994 Dec:49(12):817-.22
  2. Tabasi Z, Mahdian M, Abedzadeh-Kalahroudi Closure or non-closure of peritoneum in cesarean section: Outcomes of short term complications. Arch Trauma Res 2013 Winter;1(4):176-9.
  3. diZerega GS. The peritoneum and its response to surgical injury. Prog Clin Biol Res 1990;358(4):1-.11
  4. Hull DB, Varner MW. A randomised study of closure of peritoneum at cesarean delivery. Obstet Gynecol 1991 Jun:77(6):818-21.
  5. Nagele F , Karos H, Spitzer D, Staudach A, Karasegh S, Beck A, et al. Closure or no closure of visceral peritoneum at cesarean delivery. Am J Obstet Gynecol 1996 Apr:174(4):1366-70.
  6. IrionO, Luzuy F, Beguin F. Non closure of visceral and parietal peritoneum at cesarean section: a randomized controlled trial. Br J Obstet Gynaecol 1996 Jul;103(7):690-4.
  7. Grundsell HS, Rizk DE, Kumar RM. Randomized study of non-closure of peritoneum in lower segment cesarean section. Acta Obstet Gynecol Scand 1998 Jan:77(1):110-5.
  8. Tulandi T, Hum HS, Gelfanel MM. Closure of laparatomy incision with or without peritoneal suturing and second-look laparoscopy. Am J Obstet Gynecol 1988 Mar:158(3 Pt 1):536-7.
  9. Pietrartoni M, Parsons MT, O'Brien WF, Collins E, Knuppel RA, Spellacy WN. Peritoneal closure or non- closure at cesarean. Obstet Gynecol 1991 Feb;77(2):293-6.
  10. Ghongdemath JS, Banale A randomized study comparing non-closure and closure of visceral anparietal peritoneum during cesarean section J Obstet Gynaecol India. 2011 Feb;61(1): 48-52.
  11. Eisenach JC, Pan PH, Smiley R, Lavand'home P, Landau R, Houle TT. Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and post partum depression. Pain 2008 Nov 15;140(1):87-94.
  12. Kehlet H, Jensen TS, Woolf CJ. Persistent post surgical pain: risk factors and prevention. Lancet 2006 May

               13:367(9522):1618-.52

  1. Perry CP, Howard TM. Pelvic pain, New York: Williams and Wilkins 2000, 64(7):93-.79
  2. Ray NF, Denton WG, Thamer M, Henderson SC, Perry S. Abdominal adhesionolysis: inpatient care and expenditure in the United States in 1994. Am J Coll Surg 1998 Jan;186(1):1-9.
  3. Johnson R. Obstetric procedures. In: Edmonds DK, Dewhurst J. Dewhurst's textbook of obstetrics and gynaecology for postgraduates. 6th Oxford:Blackwell Science;1999:306-29.
  4. Rafique Z, Shibli KU, Russell IF, Lindow SW. A randomised controlled trial of the closure or non-closure of peritoneum at caesarean section: effect on post-operative pain. BJOG 2002 Jun;109(1).694-8.
  5. Hojberg KE, Aagaard J, Laursen H, Diab L, Secher NJ. Closure versus non-closure of peritonea at cesarean section--evaluation of pain. A randomized study. Acta Obstet Gynecol Scand 1998 Aug;77(7):741-5.
  6. Hajseid Javadi ES, Rasekh F. [Post-cesarean pain in closure versus non-closure of parietal peritoneum] [Article in Persian]. J Qazvin Univ Med Sci 2006;10(40):45-8.
  7. Malek-Mellonli M, Ibrahima S, Ben Amara F, Neji K, Bouchneck M, Yonssef A, et al. [Towards a simplification of caesarean section technique non-closure of peritoneum?] [Article in French]. J Gynecol Obstet Biol Reprod (Paris) 2011 Oct;40(6):541-.8
  8. Atabekoglu CS, Turkcuoglu I, Duru B, Sonmezer M, Suer G, Uysalel A, et al. Closure vs non-closure of peritoneum at caesarean section: evaluation of pain. J Obstet Gynaecol 2011 May;31(4):307-.01
  9. Anteby EY, Kruchkovich J, Kapustian V, Gdalevich M, Shenhav S, Gemer O. Short-term effects of closure versus non-closure of the visceral and parietal peritoneum at cesarean section: a prospective randomized study. J Obstet Gynaecol 2009 Dec;35(6):1026-.03