The peritoneum at laparotomy: A survey of gynaecological practice among Nigerian gynaecologists

Abstract

Background. The debate on the benefit of leaving the peritoneum unsutured is ongoing among gynaecologists. There is yet to be a final decision on this surgical step, especially considering the long-term complications of adhesion formation, subfertility and chronic pelvic pain. Objectives. The objective of the study is to determine the attitudes of Nigerian gynaecologists toward the peritoneum during laparotomy for both benign conditions and caesarean sections. Methods. The survey was conducted during the 50th International Conference of Gynaecologists hosted by the Society of Gynaecology and Obstetrics of Nigeria in October 2015. A questionnaire was distributed to attending participants across the board regarding peritoneal closure at laparotomy. A total of 125 respondents completed the survey. Data were entered into SSPA statistical software for analysis. Results. The attitude towards the peritoneum was not associated with the year of experience as a gynaecologist. The reasons for the decision not to close the peritoneum was mostly based on the little evidence there is as regards the benefits. Conclusion. The attitude towards the peritoneum during gynaecological procedures amongst Nigerian specialists appears to be in congruity with international practices where there is no clear-cut preference on the status of the peritoneum. However, the younger specialists gravitate towards non-closure.

The Surgical Technique of Caesarean Section: What is Evidence Based?

“…Closure of the peritoneum at laparotomy has been a part of standard surgical practice. Possible advantages of closing the peritoneum after caesarean section include restoration of anatomy, reduction of infection, reduction of wound dehiscence, reducing haemorrhage, and a minimisation of adhesions [59], whereas the suturing of the peritoneum may cause peritoneal tissue ischaemia at the edges, which may delay healing and serve as a cause of intraperitoneal adhesions and febrile morbidity.…”