Closure versus non-closure of peritoneum at cesarean section - evaluation of pain - a randomized study

Objective. To evaluate the effects of leaving the parietal peritoneum open at lower segment cesarean section (LSCS) measured by postoperative pain. Design. A randomized, prospective and double-blind study. Setting. Department of Obstetrics and Gynecology Aarhus University Hospital, Denmark. Population. Forty women referred for an elective cesarean section were assigned to one of two groups: peritoneum open (n=21) or peritoneum closed (n=19). Methods. Pain was evaluated twice a day from the first to the fifth postoperative day by Visual Analog Scales. Main outcome measures. Postoperative pain. Other outcomes include usage of analgesics, bowel function, postoperative complications, and hospital stay. Results. We found no overall difference in postoperative pain. A tendency to less pain was found in the non-closure group from the third postoperative day to the fifth postoperative day. No differences were found either in the incidence of postoperative complications, or the rime to return of bowel function. Concerning opiate analgesics the non-closure group had a significantly higher use in the second postoperative 24-hour period, but in the remains of the registration period it was significantly lower. For oral analgesics no difference was found in the first 24-hour period, but in the remains of the period the non-closure group had a significantly lower use. Conclusions. The VAS-scales showed no difference in postoperative pain comparing closure to non-closure of the parietal peritoneum. However, the use of analgesics is lower in the nonclosure group. We suggest leaving the parietal peritoneum open when performing LSCS.