title: Rectus muscle and visceral peritoneum closure at cesarean delivery and intraabdominal adhesions.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the effect of the rectus muscle and visceral peritoneum closure at cesarean delivery on adhesions.
  
  
  METHODS
  We performed a secondary analysis of a prospective cohort study of women who underwent first repeat cesarean delivery. Surgeons scored the severity and location of adhesions. Records were abstracted to assess previous surgical techniques.
  
  
  RESULTS
  The original cohort included 173 patients. Rectus muscle closure was associated with fewer combined filmy and dense adhesions overall (27.5% vs 46%; P = .04) and fewer dense adhesions overall (17.5% vs 46%; P = .001; adjusted odds ratio, [aOR], 0.24; 95% confidence interval [CI], 0.09-0.65), particularly from fascia to omentum (aOR, 0.08; 95% CI, 0.007-0.82). Visceral peritoneum closure was associated with increased dense fascia-to-omentum adhesions (aOR, 15.78; 95% CI, 1.81-137.24).
  
  
  CONCLUSIONS
  Closure of the rectus muscles at cesarean delivery may reduce adhesions, and visceral peritoneum closure may increase them. Surgical techniques at cesarean delivery should be assessed independently, because they may have opposite effects on adhesion formation.
authors.affiliation: Department of Obstetrics and Gynecology, Lucile S. Packard Children's Hospital, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Deirdre J
authors.initials: DJ
authors.lastname: Lyell
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
authors.forename: Emily
authors.initials: E
authors.lastname: Hu
authors.forename: Yair
authors.initials: Y
authors.lastname: Blumenfeld
authors.forename: Yasser Y
authors.initials: YY
authors.lastname: El-Sayed
authors.forename: Kay
authors.initials: K
authors.lastname: Daniels
mesh_terms: D000328:Adult; D017604:Cesarean Section, Repeat / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D010532:Peritoneal Diseases / Q000209:etiology / Q000517:prevention & control*; D010537:Peritoneum / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D011247:Pregnancy; D011446:Prospective Studies; D017568:Rectus Abdominis / Q000601:surgery*; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome