Are the skin scar characteristics and closure of the parietal peritoneum associated with pelvic adhesions?

Abstract

Objective:To assess whether the abdominal scar characteristics and closure of the peritoneum were associated with pelvic adhesions.Materials and Methods:Patients who had undergone cesarean section between December 2015 and February 2016 were assessed prospectively in terms of age, gravida, body mass index, number of living children, number of cesarean sections, time passed since the last cesarean section, closure status of the peritoneum in the last cesarean section, presence of other diseases, smoking status, location of incision in the abdomen (medial, pfannenstiel) scar dimensions (length, width), scar status with respect to skin (hypertrophic, flat, depressive), scar color [color change/no color change (hyperpigmented/hypopigmented)], adhesion of bowel-omentum-uterus, omentum-anterior abdominal wall, uterus-anterior abdominal wall, uterus-bladder, bladder-anterior abdominal wall, fixed uterus, and uterus-omentum-anterior abdominal wall in abdominal exploration.Results:One hundred five pregnant women who had undergone previous ceserean section surgery by the same physician, were at least in their 30th gestational week, had surgery notes about their previous operation, and had no chronic diseases were included in the study. Age, gravida, body mass index, number of children, number of cesarean sections, time passed since the previous cesarean section, closure/non-closure of peritoneum in the previous cesarean section, and smoking status had no effect on pelvic adhesions. Intraabdominal adhesion was not found to be associated with scar length [odds ratio (OR): 1.54, 95% confidence interval (CI): 1.1-2.2; p=0.02], depressive scar (OR: 9.3, 95% CI: 3.2-27.2; p<0.001), or hypopigmented scar [OR: 0.01, 95% CI: 0.003-0.11; p<0.001].Conclusion:Adhesions following surgical operations are of great importance due to complications for the patient, complications in relaparotomy, and high costs. Depressive and hypopigmented abdominal scars may be associated with pelvic adhesions. We believe that closure or non-closure of the parietal peritoneum is not associated with pelvic adhesions.

Skin markers and the prediction of intraabdominal adhesion during second Cesarean delivery

“…In a systemic review of 29 trials published by Bamigboye et al [18] limited and inconsistent evidence was found regarding the relationship between adhesion formation and closure versus non-closure, while the non-closure technique was associated with shorter surgical time [18] Neither of the demographic factors in this study was found to be associated with the severity of adhesions. This is similar to the results found by Taylan et al [2] Stocker et al [11] and Çim et al [19]. The current study attempted to apply two skin markers together, each of which had previously been taken by other researchers as separate factors.…”

“…Many of the abdominal scar features were considered to have an association with adhesions by many authors, such as Çim et al, who found that depressed scars with hypopigmentation are associated with adhesions [19]. Pergialiotis et al [20] undertook a meta-analysis of several observational studies and concluded that depressed scars were positively associated with intra-abdominal adhesions, while flat scars were predictive of the absence of adhesions.…”

Prediction of intraperitoneal adhesions using striae gravidarum and scar characteristics in women undergoing repeated cesarean sections

“…Scar width and appearance showed significant association with dense intraperitoneal adhesions ( p -value 0.001, and 0.002 respectively) [ 10 ]. Depressed hypopigmented scars were also associated with adhesions, which were assumed to arise from the inward traction from the adhesion bands [ 19 , 20 ]. Besides, in a meta-analysis of numerous studies, they reported that flat scars were indicative of absent adhesions while depressed ones were associated with adhesions [ 11 ].…”

Prediction of intraperitoneal adhesions using striae gravidarum and scar characteristics in women undergoing repeated cesarean sections

“…Scar width and appearance showed signi cant association with dense intraperitoneal adhesions (p-value 0.001, and 0.002 respectively) (15). Depressed hypopigmented scars were also associated with adhesions, which were assumed to arise from the inward traction from the adhesion bands (17,18). Besides, in a meta-analysis of numerous studies, they reported that at scars were indicative of absent adhesions while depressed ones were associated with adhesions (19).…”