Non-closure versus closure of peritoneum during cesarean section: a randomized study

Adhesion bands are reported to be among the most common complications of gynecological surgery procedures. The aim of this study was to compare the frequency of post-surgical adhesion among patients with closed or open peritoneal repair in the subsequent cesarean sections.

A prospective randomized trial was performed on 45 patients who underwent cesarean section during a 5-year period. Among these patients, 24 patients were operated on by closure of the peritoneum and 21 patients were operated on by the non-closure method. Overall, 31 patients had a second pregnancy and cesarean section within the time of the study. These patients were evaluated to determine if they had any adhesion between the omentum and abdominal wall or uterus or between the uterus and abdominal wall or rectus muscle.

The two groups were similar to each other with regard to the causes of cesarean section. Seven cases of adhesions were diagnosed during subsequent cesarean sections among 13 patients (54%) with peritoneal non-closure, compared with 3 in 18 women (15%) with peritoneal closure (relative risk: 3.2; 95% confidence interval: 1.0-10.2).

Closure of the peritoneum increases the operating time, but may decrease the risk of adhesions. The results of this study suggest that, during cesarean section, suture of the peritoneum may be a better option than leaving it unsutured.