Randomised control trial on immediate post-operative outcomes on patients done either closure or non-closure of peritoneum at caesarean delivery at the Kenyatta national hospital

Abstract

Objectives: To assess effects of non-closure as compared to closure of the peritoneum at caesarean delivery on the intra-operative and early post-operative outcomes.
Design: Randomised controlled trial.
Setting: Kenyatta National Hospital (KNH), Nairobi, Kenya.
Subjects: One hundred and thirty (130) women undergoing first elective or emergency caesarean delivery.
Main outcome measure: Primary outcome measures were operation time, number of sutures used, post-operative pain, febrile morbidity, wound dehiscence and hospital stay.
Results: The mean duration of Caesarean Section (CS) was 42.8 minutes ± SD12.5. The closure group took longer than non-closure group (45.7±15Vs. 39.6 ±8, P<0.05). The number of sutures used was on average were 4.7 ± SD 0.8, the closure group more compared with the non-closure group (5.2 ±0.7 Vs. 4.2 ±0.7, p<0.05). Post-operative pain was generally not a problem to the patients with a mean Visual analogue score of 1.4 ± SD 1.0 on a scale of 0-10. The non-closure group however indicated slightly more pain (1.5± SD0.93) compared with the closure group (1.2 ±1.1), but this difference was not significant. The adverse outcomes like febrile morbidity and wound complications at Caesarean section were rare and not different whether peritoneum was closed or not during Caesarean section.
Conclusion: Non-closure of peritoneum during CS took less time (42.8± SD 8) and number of sutures used (4.2±0.7) can result in cost savings. There were no statistically significant differences in post-operative pain scores, febrile morbidity, wound complications and length of hospital stay. Obstetricians and Medical institutions should consider adoption of non-closure of peritoneum at Caesarean delivery as part of the standard operating procedures.