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=?utf-8?q?Re: Yanıt: peritone?From: =?utf-8?q?Dr. Bülent Potur?= (bpotur@yahoo.com)Fri Mar 7 13:03:31 2008
Thank You John for this article. My reference was that of Ina May Gaskin. And the discussions and the thread of August 2005 in this list beginning with this message: http://forums.obgyn.net/ob-gyn-l/OBGYNL.0508/0197.html and the thread http://forums.obgyn.net/ob-gyn-l/OBGYNL.0508/index.html#197 On the other hand the article you sent did not cause any discussions in August or September 2006 in this list. http://forums.obgyn.net/ob-gyn-l/OBGYNL.0608/date.html You say that the new article is stronger evidence. It seems that they have 124 patients.: http://www.blackwell-synergy.com/doi/abs/10.1111/j.1447-0756.2006.00420.x On the other hand in 2005 the article of Stanford says that "A total of 128 patients was required to have 80% power to detect a 50% reduction in adhesions when the parietal peritoneum was left open." And they had 173 patients. http://www.greenjournal.org/cgi/content/abstract/106/2/275 I am not very good in statistics. But I am a bit confused. I think I will continue to close the peritoneum. Regards, Bülent Potur "Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C." <johnprov@sympatico.ca> wrote: J Obstet Gynaecol Res. 2006 Aug;32(4):396-402. Links Prospective study of non-closure or closure of the peritoneum at cesarean delivery in 124 women: Impact of prior peritoneal closure at primary cesarean on the interval time between first cesarean section and the next pregnancy and significant adhesion at second cesarean.Komoto Y, Shimoya K, Shimizu T, Kimura T, Hayashi S, Temma-Asano K, Kanagawa T, Fukuda H, Murata Y. Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. AIM: The aim of this study was to evaluate the effect of non-closure of the peritoneum at cesarean delivery on postoperative complications and the interval time to the next pregnancy, and to investigate the incidence of adhesion following cesarean and the association between adhesion formation and peritoneal closure. METHODS: One hundred and twenty four women scheduled for cesarean section were randomized to either closure of both the visceral and parietal peritoneum (C-group, n = 70) or non-closure (NC-group, n = 54). At repeated cesarean, the levels and extent of adhesion, operating time, and any complications were examined. RESULTS: There was no difference in the incidence of postoperative complications at the first cesarean section. The operating time of the C-group was significantly longer than that of the NC-group. The frequency of analgesic use was significantly higher in the C-group. The time interval from cesarean section to the next pregnancy in the NC-group was significantly shorter than that in the C-group. There are no significant differences between the rates of complications in the C-group and the NC-group at repeated cesarean. The incidence of adhesion in the C-group was significantly higher than that in the NC-group (P < 0.05). The mean total operating time and the mean interval time for skin incision to delivery in the C-group were significantly longer than those in the NC-group (P < 0.05 and P < 0.001, respectively) at repeated cesarean section. CONCLUSIONS: Non-closure of the peritoneum at cesarean delivery appears to have no adverse effect on postoperative recovery, it also decreases the number of analgesic doses and shortens the operating time and may be more desirable in achieving a next pregnancy. The present study demonstrated that surgical peritoneal closure resulted in more advanced adhesion formation. The practice of non-closure of the peritoneum should be performed at cesarean.
-- Take care, John
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