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n South African Journal of Obstetrics and Gynaecology - Non-closure of peritoneal surfaces at caesarean section - a systematic review

Volume 11, Issue 2
  • ISSN : 0038-2329
  • E-ISSN: 2078-5135
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Abstract

&lt;I&gt;Background.&lt;/I&gt; Caesarean section (CS) is a very common surgical procedure worldwide. Suturing the peritoneal layers at CS may or may not confer benefit, hence the need to evaluate whether this step should be omitted or not. &lt;br&gt;&lt;I&gt;Objectives.&lt;/I&gt; To assess the effects of non-closure as an alternative to closure of the peritoneum at CS on intraoperative, immediate and later postoperative, and long-term outcomes. <br><I>Search strategy.&lt;/I&gt; We searched the Cochrane Pregnancy and Childbirth Group Trials Register (November 2002) and the Cochrane Central Controlled Trials Register (October 2003). <br><I>Selection criteria.&lt;/I&gt; Randomised controlled trials that compared leaving the visceral and/or parietal peritoneum unsutured at CS with suturing the peritoneum, in women undergoing elective or emergency CS. <br><I>Data collection and analysis.&lt;/I&gt; Trial quality was assessed and data were extracted by two reviewers. <br><I>Main results.&lt;/I&gt; Nine trials involving 1 811 women were included and analysed. The methodological quality of the trials was variable. Non-closure of the peritoneum reduced operating time when both layers or one layer was not sutured. For both layers, the operating time was reduced by 7.33 minutes (95% confidence interval (CI): -8.43 - -6.24). There was significantly less postoperative fever and reduced postoperative stay in hospital for non-closure of the visceral peritoneum and non-closure of both layers. There were no other statistically significant differences. The trend for analgesia requirement and wound infection tended to favour non-closure, while endometritis results were variable. Long-term follow-up in 1 trial showed no significant differences. The power of the latter study to show differences was low. &lt;br&gt;&lt;I&gt;Conclusions.&lt;/I&gt; There was improved short-term postoperative outcome if the peritoneum was not closed. Long-term studies following CS are limited, but data from other surgical procedures are reassuring. At present there is no evidence to justify the time taken and cost of peritoneal closure.

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/content/m_sajog/11/2/EJC65783
2005-06-01
2017-11-25

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