[Towards a simplification of caesarean section technique: non-closure of peritoneum?]
M Malek-Mellouli1, S Ibrahima, F Ben Amara
1Service de gynécologie-obstétrique B, centre de maternité et de néonatologie, Tunis, Tunisie. melloulimonia@yahoo.fr
Objectives:
To assess the postoperative morbidity of a technique for caesarean section without closing the visceral and parietal peritoneum.
Patients And Methods:
We conducted a prospective cohort study randomized 252 patients over a period of four months (from March 1 to June 30, 2009). We studied the early postoperative morbidity.
Results:
Among the 252 patients, 137 were included in the group "with peritonisation" and 115 in the group "without peritonisation". Clinical and hematology maternal characteristics were comparable in both groups. The duration of intervention was reduced significantly in the absence of peritonisation (31.1 instead of 41.4 minutes; P<0.001). The postoperative pain was less but not significant between h0 and h12, however it is significant at h18, h24 and h30 in the absence of peritonisation (respectively 2.37 versus 2.81; P=0.030; 1.98 versus 2.37; P<0.001 and 1.38 versus 1.72; P=0.018). Resumption of transit was significantly faster "without peritonisation" (24.3 versus 24.7 hours; P<0.001). However, there is no significant difference between the two groups as regards the immediate postoperative complications.
Conclusion:
The absence of visceral and parietal peritoneum shortens the operative time and favors an earlier resumption of transit. It also decreases pain symptoms. We therefore recommend not to suture the parietal and visceral peritoneum during cesarean section.
