Effects of visceral peritoneal closure on scar formation at cesarean delivery

Malvasi, Antonio; Tinelli, Andrea; Farine, Dan; Rahimi, Siavash; Cavallotti, Carlo; Vergara, Daniele; Martignago, Roberta; Stark, Michael

doi:10.1016/j.ijgo.2008.12.019

Cited by 49 publications

(25 citation statements)

References 20 publications

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“…Besides studies listed on Table 1, all adhesion scoring systems were non-site-specific or unclearly described [13][14][15][16][17][18]. There were three randomized studies (Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…Komoto et al evaluated the frequency of adhesions but not the severity [15]. Malvasi et al evaluated adhesions in limited locations, primarily between the bladder and the uterus, and severity of adhesions was graded as none, mild, or severe [17].…”

Section: Resultsmentioning

confidence: 99%

“…We included studies where the adhesions were evaluated prospectively with site-specific adhesion scoring systems (Table 1) [5,11,12]. Studies with unclear evaluation of adhesions (Table 2) [13][14][15][16][17][18] and retrospective studies (Tables 3 and 4) [19][20][21][22][23][24][25] were excluded.…”

Section: Study Selectionmentioning

confidence: 99%

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Classification of intra-abdominal adhesions after cesarean delivery

Tulandi

Lyell

2012

Gynecol Surg

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The objective of the study was to develop a standard classification for adhesions after cesarean delivery. We searched the Medline, Pubmed, EMBASE, and the Cochrane database of systematic reviews from 1996 through 2011 for all articles pertaining to adhesion scoring after a cesarean delivery. We performed the search using the keywords "cesarean, adhesions, repeat cesarean, intra-abdominal adhesions, adhesion scoring system, and adhesion classification." Most published adhesion scoring systems were non-site-specific or unclearly described. The most comprehensive adhesion scoring systems were described in three prospective studies that came from two institutions. The scoring systems were similar, site-specific, involving over four sites, and assessing the severity and consistency of adhesions. We combined the two scoring systems to develop a standardized classification of adhesions after cesarean delivery. To date, there are no uniform classifications of intra-abdominal adhesions after cesarean delivery. We hereby outline the first standardized classification of adhesions after cesarean delivery.

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“…Besides studies listed on Table 1, all adhesion scoring systems were non-site-specific or unclearly described [13][14][15][16][17][18]. There were three randomized studies (Table 2).…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Classification of intra-abdominal adhesions after cesarean delivery

Tulandi

Lyell

2012

Gynecol Surg

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“…86 However, studies on this subject have concluded that insufficient data are available to make a pronouncement on the issue and that adequately powered and appropriately designed trials are needed. 87,88 A recent study by Malvasi and colleagues 89 supports nonclosure of the visceral peritoneum for CD. These authors performed light microscopy and scanning electron microscopy on specimens obtained from patients having a repeat CD following nonclosure and closure of the peritoneum in their first CD.…”

Section: Closure and Nonclosure Of The Visceral And Parietal Peritoneummentioning

confidence: 92%

Postoperative Adhesion Development Following Cesarean and Open Intra-Abdominal Gynecological Operations

et al. 2011

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In this review, we discuss the pathophysiology of adhesion development, the impact of physiological changes associated with pregnancy on markers of adhesion development, and the clinical implications of adhesion development following cesarean delivery (CD). Although peritoneal adhesions develop after the overwhelming majority of intra-abdominal and pelvic surgery, there is evidence in the literature that suggests that patients having CD may develop adhesions less frequently. However, adhesions continue to be a concern after CD, and are likely significant, albeit on average less than after gynecological operations, but with potential to cause significant delay in the delivery of the baby with serious, lifelong consequences. Appreciation of the pathophysiology of adhesion development described herein should allow a more informed approach to the rapidly evolving field of intra-abdominal adhesions and should serve as a reference for an evidence-based approach to consideration for the prevention and treatment of adhesions.

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“…The longterm follow-up showed no differences in pain, fertility, urinary symptoms, and adhesions [38,44,45]. It is proven that closure of the visceral peritoneum at cesarean delivery may produce an inflammatory reaction and adhesions, caused by reactive and regenerative mesothelial hyperplasia and submesothelial fibrosis [33].…”

Section: Expansion Of Uterine Incisionmentioning

confidence: 99%

Technical aspects of the cesarean section

et al. 2010

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The aim of this study was to evaluate every part of the surgical procedure during cesarean section (CS) to prevent complications and improve the clinical outcome. We researched on PubMed, Medline, and Cochrane. The evidence-based research suggests a transverse incision of the skin, blunt dissection of the subcutaneous tissue, omission of the bladder flap, blunt extension of the hysterotomy, prophylactic antibiotics, spontaneous placental removal, leaving the peritoneum open, and suture closure of the subcutaneous tissue when thickness is ≥2 cm. We hope that all evidence-based description will help to perform the CS safer, and for all surgical procedures not yet studied, further research is needed.

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Effects of visceral peritoneal closure on scar formation at cesarean delivery

Abstract: Closure of the visceral peritoneum at cesarean delivery may produce an inflammatory reaction and adhesions, evidenced by reactive and regenerative mesothelial hyperplasia and submesothelial fibrosis.

Cited by 49 publications

References 20 publications

Classification of intra-abdominal adhesions after cesarean delivery

Classification of intra-abdominal adhesions after cesarean delivery

Postoperative Adhesion Development Following Cesarean and Open Intra-Abdominal Gynecological Operations

Technical aspects of the cesarean section

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