PERITONEAL NON-CLOSURE AT CAESAREAN SECTION � A STUDY OF SHORT TERM POST OPERATIVE MORBIDITY

Peritoneal Non-Closure at Caesarean Section

Abstract

Objective: To assess the intra-operative and immediate post-operative effects of non-closure of parietal and visceral peritoneum during caesarean section.
Study Design: Randomized control trial.
Place and Duration: Department of Gynaecology and Obstetrics, Combined Military Hospital, Lahore; from 1 Jan 05 to 30 Jun 05 (6 months).
Patients and Methods: A total of 306 women undergoing caesarean section were randomly allocated to standard routine closure (control group n= 157), and non-closure of both peritoneal layers (study group n=149). Preoperative, intra and postoperative management decisions were made without reference to either group specifically. Statistical analysis compared incidences of immediate post operative complications. Main outcome measures were mean operative and anesthesia time, intra operative blood loss, post operative febrile morbidity and analgesia requirements, post operative bowel function and paralytic ileus, rate of wound infection/dehiscence and length of hospital stay in both groups.
Results: The mean operative time was reduced by seven minutes (p< 0.01), and hospital stay was 01 day less (p< 0.01) in study group. There was no difference in rate of febrile and infectious morbidity or in level of post operative pain and number of analgesic doses in both groups. The difference b/w the frequency of postoperative items was also insignificant (p>0.05)
Conclusion: Peritoneal non-closure is recommended during caesarean section because it results in significantly shorter operative time and hospital stay, decreased anesthetic dosage, quicker return of bowel activity and thus conferred significant patient and economic benefit.