Closure of peritoneum at laparotomy - A survey of gynaecological practice
1999
Background . The traditional practice of gynaecological surgeons has been to close the peritoneal surfaces at laparotomy. Experimental and clinical trials have shown no advantage associated with closure of peritoneum. The objective of this study was to detennine the attitude and practice of gynaecologists regarding peritoneal closure at laparotomy. Methods . Questionnaires were faxed to, or telephonic - interviews conducted with, 145 registered gynaecologists in Gauteng concerning their practices of peritoneal closure or non-closure at laparotomy. One hundred and one respondents replied and all data were entered onto a database (Epi-Info 6) for analysis. Results . The response rate was 70% (101/145). Peritoneal closure was performed more frequently by private obstetricians and gynaecologists than by those who work either' part-time or full-time in government institutions. Significantly more respondents in private practice than those who practise in government institutions close parietal peritoneum during caesarean section (92% v. 58%). The same trend was noted for abdominal hysterectomy (92% v. 61%, respectively). Restoration of anatomy (39% in private practice v. 27% in government institutions) and prevention of adhesion formation (36% in private v. 30% in government service) are the hvo most important reasons given'by both groups for closure of peritoneal surfaces. Conclusion . The majority of specialists close peritoneal surfaces during the various surgical procedures in obstetrics and gynaecology, despite evidence that this practice does not improve surgical outcome.
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