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To peritonealize or not to peritonealize? A randomized trial at abdominal hysterectomy
1Department of Obstetrics and Gynaecology, Ninewells Hospital and Medical School, Dundee, United Kingdom.
Objectives:
Our purpose was to determine whether nonclosure of the visceral and parietal peritoneum alters the intraoperative or postoperative course at abdominal hysterectomy.
Study Design:
The setting was a gynecology unit in a university teaching hospital. A parallel-group, single-blind randomized controlled trial was performed on 144 women who underwent abdominal hysterectomy with or without salpingo-oophorectomy. Seventy-six women were allocated to the control "closed" group and 68 women to the study "open" group. The main outcome measures were operative time, estimated blood loss, postoperative pain assessed by visual analog scale, and amount of postoperative analgesia.
Results:
The mean operative time was shorter by 10 minutes (p < 0.001) and there was a 45 ml reduction of estimated blood loss in the nonclosure group (p=0.03). There were no differences in postoperative pain in the two groups.
Conclusions:
Peritoneal closure at abdominal hysterectomy provides no immediate postoperative benefits while unnecessarily lengthening surgical time and anesthesia exposure. We suggest that the traditional practice of visceral and parietal peritoneal closure be abolished at abdominal hysterectomy.