Closure or nonclosure of the visceral peritoneum at cesarean delivery.
OBJECTIVE
Our purpose was to determine whether nonclosure of the visceral peritoneum at low transverse cesarean delivery has advantages over suture peritonization with regard to postoperative morbidity.


METHODS
A prospective randomized trial of 549 women undergoing cesarean section was carried out; 262 were randomized to nonclosure and 287 to closure of the visceral peritoneum. Perioperative, intraoperative, and postoperative management decisions were made without reference to treatment groups. Statistical analysis compared intraoperative and postoperative outcome between the two groups.


RESULTS
Operating and anesthesia times were significantly shorter in patients receiving nonclosure. The incidence of febrile morbidity and cystitis and the need for antibiotics and narcotics were all significantly greater when the peritoneum was closed. Hospital stay was significantly shorter after nonclosure.


CONCLUSIONS
Nonclosure of the visceral peritoneum is associated with lower febrile and infectious morbidity. Routine closure of the visceral peritoneum should be abandoned at cesarean delivery.
Nagele
F
F
Department of Obstetrics and Gynecology, University Hospital of Vienna, Austria.
Karas
H
H
Spitzer
D
D
Staudach
A
A
Karasegh
S
S
Beck
A
A
Husslein
P
P
D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods*; D003556:Cystitis / Q000453:epidemiology; D005260:Female; D005334:Fever / Q000453:epidemiology; D006801:Humans; D007902:Length of Stay; D010537:Peritoneum / Q000601:surgery*; D011183:Postoperative Complications; D011247:Pregnancy; D011446:Prospective Studies; D013537:Sutures