THE EFFECT OF CLOSURE OF PERITONEUM AND ANATOMICAL LAYERS ON ADHESION FORMATION IN PATIENTS UNDERGOING CESAREAN SECTIONGultekin Kocun
This study is to investigate the effect of closure of the peritoneum and other anatomical layers on adhesion formation in patients undergoing cesarean section and to compare the effect of different closures of layers on adhesion formation. The operation notes of 1021 patients were retrospectively analyzed and the abdominal closure technique in the previous cesarean section was recorded. The presence and severity of adhesion in the second cesarean section were recorded using the NAIR’s classification which was previously defined by the same operator. Four groups were formed according to the closure technique and the groups were compared with each other according to the adhesion scale recorded during the second cesarean section. There was no statistically significant difference between the groups in terms of age, BMI, number of pregnancies, and cesarean section. Among the 4 groups formed according to the closure technique, the rate of adhesion formation was statistically the highest in the group in which the fascia was closed directly after the closure of the uterus. Adhesion formation has decreased significantly as the number of sutured anatomical layers increased. Adhesion severity was found to be statistically significantly higher in the direct closure group. As the number of sutured layers increased, the severity of adhesion was found to be significantly lower. The operative time was found to be significantly longer than the severity of adhesion. Although not statistically significant, two major organ injuries occurred in the group without layered closure. The second operative time was found to be significantly higher as the severity of adhesion increased.
Keywords: Cesarean section, Adhesion incidence, Peritoneal closure, Operative time