[Closure or non closure of the peritoneum at cesarean section in 2008?].
Non closure of the peritoneum at cesarean is still debatable, despite the national and international guidelines. This review aims at exposing risks and benefits of non closure of the peritoneum, focusing on the peritoneum adhesions. Many studies demonstrated no benefits at peritoneum closure in the duration of surgery, the immediate postoperative period and the short-term complications. Data about pelvic adhesion risk are more inconsistent. Different criteria were considered in the studies: adhesions incidence and density during subsequent cesareans or pelvic surgeries, duration of surgery and the delay between incision and birth during the subsequent cesarean and fertility known to be impaired by thick-pelvic adhesions. Most of the studies are exhibiting serious bias, leading to weak conclusions. However, two randomised controlled trials compared pelvic adhesion in the subsequent c-section, in step with closure or non closure of the parietal and visceral peritoneum at first caesarean. The results showed that non closure of the peritoneum does not increase or even reduce the adhesions risk. These results are consistent with results from three studies reporting no modification of patient fertility. As a conclusion, current data are supporting the national and international medical society recommendations about the benefits of the non closure of the peritoneum at caesarean section.
Doret
M
M
Département de gynécologie-obstétrique, Hospices Civils de Lyon, hôpital Femme-Mère-Enfant, Lyon, France. muriel.doret@chu-lyon.fr
Gaucherand
P
P
D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D010532:Peritoneal Diseases / Q000209:etiology* / Q000517:prevention & control*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome