A COMPARATIVE STUDY BETWEEN CLOSURE VERSUS NON-CLOSURE OF PERITONEUM DURING CAESAREAN SECTION

Abstract

AIMS : To assess the short term outcome of closure versus non-closure of both visceral and parietal peritoneum during caesarean section on basis of Duration of surgery (to compare operative time in both groups),Post-operative pain,Use of analgesics,Return of bowel movements and Postoperative febrile episodes STUDY SETTING: This study was conducted in Department of Obstetrics and Gynecology , Guru Gobind Singh Medical College and Hospital, Faridkot. STUDY DESIGN: This was a randomized controlled trial of over 300 patients consisting of 2 groups. Group 1 undergoing closure of peritoneum (control group) and Group 2 with non-closure of peritoneum (study group). The study was approved by the Institutional Ethics Committee. Methods and Material: Atotal of 300 cases undergoing emergency or elective lower segment caesarean section were recruited for the study . The study was approved by the Institutional Ethics Committee. After a detailed history, general physical examination, obstetric examination and routine investigations, informed consent was taken from each patient for participation in the study. Group allocation was done using Microsoft excel where randomization was done using serial number of patients prior to commencement of the study and the women were randomly allocated to one of the two groups (closure or non-closure group 150 in each) . Results: In the present study, mean age of the patients of the closure group and non-closure group was 29.2 years and 28.1 years respectively. Mean duration of procedure among patients of the closure group and non-closure group was 39.69 minutes and 32.26 minutes respectively.Among the patients of the closure group, mean VAS(Visual Analogue Scale) at immediate postoperative period, at postoperative 6 hours, postoperative 12 hours and postoperative 24 hours was found to be 4.8, 6.33, 4.61 and 3.86 respectively. In the present study, 8 percent of the patients of the nonclosure group while 10.4 percent of the patients of the closure group had incidence of postoperative febrile episode . Mean time for returning of bowel movements for the patients of the closure group and non-closure group was 1.72 days and 1.49 days respectively. Mean duration of hospital stay among the patients of the closure group and non-closure group was 2.3 days and 2.06 days respectively . Postoperative wound infection was present in 1.6 percent of the patients of the closure group and 1.6 percent of the patients of the non-closure group. Postoperative wound dehiscence was present in 0.8 percent of the patients of 55 the closure group and 0.8 percent of the patients of the non-closure group . Conclusions: Avoiding the closure of visceral and parietal peritoneum at caesarean delivery is associated with lesser operating time, decreased incidence of febrile morbidity and lesser need for postoperative analgesics. Hence , routine closure of peritoneum at caesarean section can be avoided.