Incidence of significant adhesions at repeat cesarean section and the relationship to method of prior peritoneal closure

To examine the effect of peritoneal closure at prior cesarean section on the occurrence of abdomino-pelvic adhesions at subsequent cesarean section.

An observational chart review study was performed involving 191 cases of repeat cesarean section occurring from January 2001 through July 30, 2002. An adhesion score was created according to the following: a grade 1 score was assigned when no adhesions were present, a grade 2 when adhesions were present but no surgery required, a grade 3 when adhesiolysis was required and there was inability to exteriorize the uterus, and a grade 4 when adhesiolysis was required prior to delivery. Scores were assigned and tabulated as a result of the review of the operative records of 191 cases. When available, the operative record of prior cesarean section was examined to determine if visceral and parietal peritoneal closure had been performed at the prior operation.

During the year and a half for which data were examined, significant abdominopelvic adhesions (grades 3 and 4) were encountered 21% of the time (40 of 191) at repeat cesarean section. Prior peritoneal closure resulted in significant adhesions in 1 of 18 patients compared to 17 of 40 patients when no prior peritoneal closure was recorded (Fisher's exact probability = 0.003).

While preliminary, in the absence of any substantive benefit or published data regarding adhesionformation in cesarean section that contradict this finding, the practice of nonclosure of visceral and parietal peritoneum at cesarean section should be questioned.