Non-closure of peritoneal surfaces at caesarean section--a systematic review.
BACKGROUND
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.


OBJECTIVE
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.


METHODS
We searched the Cochrane Pregnancy and Childbirth Group Trials Register (November 2002) and the Cochrane Central Controlled Trials Register (October 2003).


METHODS
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.


METHODS
Trial quality was assessed and data were extracted by two reviewers.


RESULTS
Nine trials involving 1811 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.


CONCLUSIONS
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.
Bamigboye
Anthony Akinloye
AA
Rob Ferreira hospital, Nelspruit. anthony.bamigboye@email.mediclinic.co.za
Hofmeyr
G Justus
GJ
D002585:Cesarean Section / Q000379:methods*; D003625:Data Collection; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D010537:Peritoneum / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D013536:Suture Techniques; D013537:Sutures; D013997:Time Factors