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

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.