CLOSURE OR NONCLOSURE OF THE VISCERAL PERITONEUM IN ABDOMINAL HYSTERECTOMY

The purpose of this study was to test the hypothesis that nonclosure of the visceral peritoneum in abdominal hysterectomy has distinct advantages over suture reperitonealization with regard to postoperative morbidity. A prospective clinical investigation in 211 women undergoing abdominal hysterectomy was carried out. One hundred five patients were randomized into the nonclosure, open group, and another 106 subjects were randomized to closure of the visceral peritoneum by sutures, closed group. The postoperative course was determined by analyzing febrile morbidity and both immediate and late complications. Statistical comparisons used chi(2) and Mann-Whitney U-test. There was no significant difference between the two groups in the temperature curves in the first week after surgery. The number of patients requiring antibiotics for various complications was significantly higher in patients of the closed group (p = 0.03), especially because of the higher incidence of sub-febrile developments (>37.5 degrees C>2 days) and cystitis. In each group we had 1 case of ileus in the immediate postoperative period. There were 2 late complications in the open group that were not in any way connected to the method of surgery. Nonclosure of the visceral peritoneum simplifies the surgical technique and results in a smaller number of postoperative complications. Furthermore, it has no adverse effects on both febrile morbidity and postoperative recovery. This study questions the necessity of the time-honored practice of routinely closing the visceral peritoneum in women undergoing abdominal hysterectomy.