Closure versus non-closure of the peritoneum at caesarean section.

BACKGROUND: Caesarean section is a very common surgical procedure world wide. 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 intra-operative, immediate and long-term postoperative and long-term outcomes.

SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register (November 2002).

SELECTION CRITERIA: Controlled trials comparing leaving the visceral and/or parietal peritoneum unsutured at caesarean section with a technique which involves suturing the peritoneum in women undergoing elective or emergency caesarean section.

DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted by two reviewers.

MAIN RESULTS: Nine trials involving 1811 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 7.33 minutes, 95% confidence interval (CI) -8.43 to -6.24. There was significantly less postoperative fever and reduced postoperative stay in hospital for visceral peritoneum and for both layer non-closure. There were no other statistically significant differences. The trend for analgesia requirement and 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.

REVIEWER'S CONCLUSIONS: There was improved short-term postoperative outcome if the peritoneum was not closed. Long-term studies following caesarean section are limited, but data from other surgical procedures are reassuring. There is at present no evidence to justify the time taken and cost of peritoneal closure.