TO PERITONEALIZE OR NOT TO PERITONEALIZE - A RANDOMIZED TRIAL AT ABDOMINAL HYSTERECTOMY

OBJECTIVES: Our purpose was to determine whether nonclosure of the vis ceral and parietal peritoneum alters the intraoperative or postoperati ve course at abdominal hysterectomy. STUDY DESIGN: The setting was a g ynecology unit in a university teaching hospital. A parallel-group, si ngle-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 v isual analog scale, and amount of postoperative analgesia. RESULTS: Th e 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 pro vides no immediate postoperative benefits while unnecessarily lengthen ing surgical time and anesthesia exposure. We suggest that the traditi onal practice of visceral and parietal peritoneal closure be abolished at abdominal hysterectomy.