Closure versus non-closure of the peritoneum at caesarean section

Cochrane Review by Bamigboye AA, Hofmeyr GJ

This record should be cited as: Bamigboye AA, Hofmeyr GJ. Closure versus non-closure of the peritoneum at caesarean section. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD000163. DOI: 10.1002/14651858.CD000163.

ABSTRACT

Title

Closure versus non-closure of the peritoneum at caesarean section

Background

Caesarean section is a very common surgical procedure worldwide. Suturing the peritoneal layers at caesarean section may or may not confer benefit, hence the need to evaluate whether this step should be omitted or not.

Objectives

The objective of this review was to assess the effects of non-closure as an alternative to closure of the peritoneum at caesarean section on intraoperative, immediate and long-term postoperative and long-term outcomes.

Search strategy

We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (October 2006).

Selection criteria

Controlled trials comparing leaving the visceral or parietal peritoneum, or both, unsutured at caesarean section with a technique which involves suturing the peritoneum in women undergoing elective or emergency caesarean section.

Data collection and analysis

Two review authors assessed trial quality and extracted the data.

Main results

Fourteen trials, involving 2908 women, were included and analysed. The methodological quality of the trials was variable. Non-closure of the peritoneum reduced operating time whether both or either layer was not sutured. For both layers, the operating time was reduced by 6.05minutes, 95%confidence interval (CI) -6.74 to -5.37. There was significantly less postoperative fever and reduced postoperative stay in hospital for visceral peritoneum and for both layer non-closure. The number of postoperative analgesic doses was reduced in the peritoneal non-closure group (weighted mean difference -0.20, 95% CI -0.33 to -0.08). There were no other statistically significant differences. The trend for wound infection tended to favour non-closure, while endometritis results were variable. Long-term follow up in one trial showed no significant differences. The power of the study to show differences was low.

Authors' conclusions

There was improved short-term postoperative outcome if the peritoneum was not closed. This in itself can support those who opt not to close the peritoneum. Long-term studies following caesarean section are limited; there is therefore no overall evidence for nonclosure until long-term data become available.