Effect of Hysterotomy Closure With Polyglactin 910 Versus Chromic Gut Suture on Secondary Cesarean Deliveries [12P

Abstract

INTRODUCTION: The objective of this was study was to determine if hysterotomy closure with polyglactin 910 (PG) versus chromic gut (CG) suture material is associated with differences in development of adhesions and surgical complications in secondary cesarean deliveries (CD). METHODS: We conducted a 3 year retrospective cohort study and reviewed charts on all women who received a secondary CD. Operative notes were reviewed and charts were separated depending if closure of the hysterotomy was performed with PG or CG. Charts were excluded if at time of primary CD, a double layer closure of hysterotomy, closure of peritoneum and rectus muscle were not performed, or additional procedure was performed. Appropriate IRB approval was obtained. Primary outcomes included operating time, surgical blood loss, and report of “dense” or “extensive” adhesions (DEA) requiring lysis of adhesions and/or enterolysis as a separate procedure. RESULTS: The study included 313 patients, where 181 patients had hysterotomy closures with PG and 132 had closures with CG. Baseline characteristics were not significantly different between groups including previous abdominal surgery. The CG group was associated with lower rates of DEA (19% versus 21%, P=.031) and shorter total operative time (1.1 hours versus 1.9 hours, P=.024). No difference was noted in surgical blood loss or rates of postpartum hemorrhage. After controlling for perceived confounding factors, these differences remained significant. CONCLUSION: In this retrospective study, hysterotomy closures with CG suture were associated with lower rates of reported adhesions and decreased total operative time when compared with PG closures.