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We appreciate the interest of Drs Pelosi in our article.1.Tulandi T. Al-Jaroudi D. Non-closure of peritoneum: a reappraisal.Am J Obstet Gynecol. 2003; 189: 609-612Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar They proposed to suture the peritoneum if the rectus muscle is transected during a cesarean section. Otherwise, severe adhesions might develop between the uterus and the undersurface of the rectus muscle. Because adhesions are formed if 2 raw surfaces are in apposition, this is certainly a possibility. On a few occasions, we have also encountered thick bands of fibromuscular adhesions between the uterus and the anterior abdominal wall after cesarean section. Whether this is related to transaction of the rectus muscle and nonclosure of peritoneum is unclear. Without a comparison group of closed peritoneum but very much similar patients, it is impossible to assess the findings with any confidence. Several randomized trials2.Irion O. Luzuy F. Beguin F. Nonclosure of the visceral and parietal peritoneum at cesarean section: a randomized controlled trial.BJOG. 1996; 103: 690-694Crossref Scopus (84) Google Scholar, 3.Ohel G. Younis J.S. Lang N. Levit A. Double-layer closure of uterine incision with visceral and parietal peritoneal closure: are they obligatory steps of routine cesarean sections?.J Maternal Fetal Med. 1996; 5: 366-399PubMed Google Scholar, 4.Rafique Z. Shibli K.U. Russell I.F. Lindow S.W. A randomized controlled trial fo the closure or non-closure of peritoneum at caesarean section: effect on postoperative pain.BJOG. 2002; 109: 694-698Crossref PubMed Scopus (56) Google Scholar have shown that closing the peritoneum either parietal or visceral peritoneum is unnecessary, is associated with slightly longer operating time, more postoperative pain, and there is a suggestion that it might cause more adhesion formation. In general, there are more advantages than disadvantages of not closing the peritoneum.