CLOSURE OR NONCLOSURE OF THE VISCERAL PERITONEUM AT CESAREAN DELIVERY

OBJECTIVE: Our purpose was to determine whether nonclosure of the visc eral peritoneum at low transverse cesarean delivery has advantages ove r suture peritonization with regard to postoperative morbidity. STUDY DESIGN: A prospective randomized trial of 549 women undergoing cesarea n section was carried out; 262 were randomized to nonclosure and 287 t o closure of the visceral peritoneum. Perioperative, intraoperative, a nd postoperative management decisions were made without reference to t reatment groups. Statistical analysis compared intraoperative and post operative outcome between the two groups. RESULTS: Operating and anest hesia times were significantly shorter in patients receiving nonclosur e. The incidence of febrile morbidity and cystitis and the need for an tibiotics and narcotics were all significantly greater when the perito neum was closed. Hospital stay was significantly shorter after nonclos ure.CONCLUSION: Nonclosure of the visceral peritoneum is associated wi th lower febrile and infectious morbidity. Routine closure of the visc eral peritoneum should be abandoned at cesarean delivery.