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Peritoneal closure versus no peritoneal closure for patients undergoing non-obstetric abdominal operations

Creator:

Gurusamy, K.S., et al

Subject Keywords: To compare the benefits and harms of parietal peritoneal closure compared with no parietal peritoneal closure in patients undergoing non-obstetric abdominal operations
Type: Article
Region: International (other)
Description:

The peritoneum is the inner lining of the abdomen (tummy). After surgery, when closing the abdomen, some surgeons stitch the peritoneum together because they think this increases the strength of the wound. Others do not stitch the peritoneum together because they think it is unnecessary, increases operating costs through use of additional stitching material, increases operating time, and may increase pain. So, whether to close the peritoneum, and method of closure (continuous running stitches versus interrupted stitches) are controversial in operations not related to childbirth. We addressed these controversies by performing a thorough search of the medical literature for trials that compared closing and not closing the peritoneum after abdominal operations not related to childbirth. We included only randomised controlled trials without limiting trials according to language or year of publication, or number of participants in the study. Two review authors independently identified the trials and extracted information.

We identified five trials involving 836 participants who had open abdominal operations. Peritoneal closure was done in 410 participants and not done in 426. All trials had a high risk of bias. Only one trial reported the proportion of participants who died up to one year after the operation, and there was no significant difference between the closure and non-closure groups. Three trials reported major wound breakdown (burst abdomen), which requires emergency surgery. Overall, 10/663 participants (1.5%) developed burst abdomen, with no significant difference in proportions between the two groups. Three trials reported minor wound breakdown (incisional hernia), that may require surgery. Overall, 17/663 participants (2.5%) developed incisional hernia; again there was no significant difference between the two groups.

None of the trials reported on important outcomes, such as quality of life; the occurrence of intestinal obstruction (caused by intestines sticking to themselves and the abdominal wall (adhesions)); or the proportion of participants who had surgery to fix incisional hernia or adhesions. Only one trial reported length of hospital stay, and showed no significant difference between the groups, but did not include readmissions in its calculations. There does not appear to be any evidence for a short-term or long-term advantage in peritoneal closure in operations not related to childbirth. However, the trials were at high risk of bias, which can lead to false conclusions. Interestingly, our findings are similar to those of another research group who performed a similar review for operations related to childbirth.

Date:

04/07/2013

Rights: © The Cochrane Collaboration
Suggested citation:

Gurusamy, K.S., et al. (2013) Peritoneal closure versus no peritoneal closure for patients undergoing non-obstetric abdominal operations [Online]. Available from: http://publichealthwell.ie/node/525392 [Accessed: 25th August 2019].

  

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