"This was a surprise finding," said Deirdre Lyell, MD, assistant professor of obstetrics and gynaecology and lead author of a paper appearing in the August issue of Obstetrics and Gynaecology. "We were fully expecting to find that closing the peritoneum at caesarean delivery would increase adhesions."
Although the tradition had been to close the peritoneum following delivery, recent short-term studies have linked such closures with increased operation time and postoperative pain. There has also been concern that closure of the peritoneum at caesarean may lead to adhesions - which can cause problems such as bowel obstruction, chronic pelvic pain and infertility, and can make future surgeries longer and more difficult-though such a connection lacks sufficient supporting data.
Lyell and her colleagues launched a study involving 173 women at Stanford who were undergoing a repeat caesarean. During the study, surgeons were asked after surgery to score the severity and location of any adhesions. The researchers then examined patient records to determine whether a participant's first caesarean included peritoneal closure; it had for about 39 percent of the women.
The researchers found that patients whose peritoneum was surgically closed following their first delivery were significantly less likely to have developed abdominal adhesions: 52 percent of patients with prior closure had adhesions versus 73 percent of non-closure patients. When controlling for potential confounding variables, the researchers determined that closing the peritoneum offered five times as much protection against the formation of adhesions as leaving it open. It also offered three times as much protection against dense adhesions, which are considered the most difficult to treat.
Based on the results, the authors noted that "the practice of non-closure of the parietal peritoneum at caesarean delivery should be questioned."
MEDICA.de; Source: Stanford University