Closure of peritoneum at laparotomy - A survey of gynaecological practice

Background. The traditional practice of gynaecological surgeons has been to close the peritoneal surfaces at laparotomy. Experimental and clinical tri als have shown no advantage associated with closure of peritoneum. The obje ctive of this study was to determine the attitude and practice of gynaecolo gists regarding peritoneal closure at laparotomy. Methods. Questionnaires were faxed to, or telephonic interviews conducted w ith, 145 registered gynaecologists in Gauteng concerning their practices of peritoneal closure or non-closure at laparotomy. One hundred and one respo ndents replied and all data were entered onto a database (Epi-Info 6) for a nalysis. Results. The response rate was 70% (101/145). Peritoneal closure was perfor med more frequently by private obstetricians and gynaecologists than by tho se who work either part-time or full-time in government institutions. Signi ficantly more respondents in private practice than those who practise in go vernment institutions close parietal peritoneum during caesarean section (9 2% v. 58%). the same trend was noted for abdominal hysterectomy (92% v. 61% , respectively). Restoration of anatomy (39% in private practice v. 27% in government institutions) and prevention of adhesion formation (36% in priva te v. 30% in government service) are the two most important reasons given b y both groups for closure of peritoneal surfaces. Conclusion. The majority of specialists close peritoneal surfaces during th e various surgical procedures in obstetrics and gynaecology, despite eviden ce that this practice does not improve surgical outcome.