title: Peritoneal adhesion prevention at cesarean section: an analysis of the effectiveness of an absorbable adhesion barrier.
abstract: OBJECTIVE
  To evaluate the effectiveness of an absorbable adhesion barrier utilized at cesarean delivery.
  
  
  METHODS
  We performed a retrospective, two-arm cohort, chart review of primary and subsequent first repeat cesarean sections from January 1, 2006-December 31, 2009. Exclusion criteria were incomplete operative report, history of prior abdominal-pelvic surgery, pelvic inflammatory disease, chorioamnionitis, emergency cesarean delivery or use of corticosteroids within 2 weeks. Adhesion incidence/severity as well as skin incision to newborn delivery times were analyzed. Effects of peritoneal closure and suture types were examined.
  
  
  RESULTS
  Of 262 primary cesareans performed, 43% (N= 112) had repeat cesarean section. With barrier, 74% had no adhesions at repeat surgery, versus 22% in the no barrier group (p = 0.011). Eleven percent had grade 2 adhesions with barrier, while 64% had grade 2-3 in the no barrier group (p = 0.012). The barrier group had no grade 3 adhesions. Those with parietal peritoneal closure had less incidence (p = 0.02) and mean adhesion severity (p = 0.03); no significant difference was found per suture type. No statistical difference in time from skin incision to newborn delivery was noted between primary and barrier group (p = 0.006); those without barrier had a statistically longer delivery interval (p = 0.35).
  
  
  CONCLUSIONS
  Use of an absorbable adhesion baóóórrier reduces the incidence and severity of adhesions at cesarean.
authors.affiliation: Women's Specialty Center, Dallas, Texas, USA. chapamd@gmail.com
authors.forename: Hector O
authors.initials: HO
authors.lastname: Chapa
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Venegas
authors.forename: Charles P
authors.initials: CP
authors.lastname: Vanduyne
authors.forename: Alfred G
authors.initials: AG
authors.lastname: Antonetti
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Sandate
authors.forename: Lori
authors.initials: L
authors.lastname: Silver
mesh_terms: D000328:Adult; D002483:Cellulose, Oxidized / Q000627:therapeutic use*; D002585:Cesarean Section / Q000009:adverse effects*; D017604:Cesarean Section, Repeat / Q000009:adverse effects; D015331:Cohort Studies; D005260:Female; D006801:Humans; D011247:Pregnancy; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control*
chemical_list: D002483:Cellulose, Oxidized; C060002:INTERCEED