الفهرس 
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Abstract
Cesarean section (CS) can be considered as one of the most frequently performed surgical procedure worldwide, accounting for up to 70% of deliveries, depending on the facility being assessed and the country involved. In general, rate around the world are from 5% to over 20%of all deliveries.
Traditionally, suturing of peritoneal layers in CS have been done, this stage could be easily eliminated since it does not increase the rate of morbidity. Reasons noted for closure of the peritoneum include restoring anatomy and reapproximating tissues, reducing infection by re-establishing an anatomical barrier, decreasing wound dehiscence, reducing hemorrhage and minimizing adhesions. However, the advantages of this technique have not been proved by prospective randomized trials. Prior animal experiments and general surgery reports have shown that peritoneal closure tends to cause tissue ischemia, inflammation, and foreign body reactions to suture material. These factors may slow down the healing process and are considered important precursors for adhesion formation. Peritoneum is a mesothelial organ. In contrast to epidermal repair, where healing occurs gradually from wound borders, peritoneum heals simultaneously throughout the wound because mesothelial cells initiate multiple sites of repair. If the peritoneum is left open, experimental studies have shown that a spontaneous healing will appear within 48–72 hours after injuring the peritoneum with complete healing after five to six days.
The present study is a comparative study that was conducted to compare the early postoperative outcomes within 1st 24 hours following cesarean section using peritoneal closure technique versus peritoneal non closure technique. The study included 80 patients with age range from 18 to 40 years subjected to cesarean section, who were
Summary
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divided into two groups. Group I (Control) 40 patients with closure of both the visceral and parietal peritoneum,30 patients with previous cesarean section (IA) and ten patients with 1st cesarean section (IB).Group II (Study) 40 patients with non closure of both the visceral and parietal peritoneum ,30 patients with previous cesarean section (IIA) and ten patients with 1st cesarean section (IIB).
The study was approved by the Local Ethics Committee of Deputy of Research of Menoufiya University and written informed consent was obtained from each subject after discussing study objectives. Eighty women undergoing elective CS were randomly selected to receive either closure or non-closure of peritoneum, Patients with previous surgical lower abdominal operations other than CS, febrile morbidity prior to the operation defined as temperature above 38ºc, sensory or motor deficit affecting the abdomen or the lower limbs, debilitating disease affecting wound healing (diabetes mellitus), premature rupture of membrane , preoperative bleeding and patients known to have bowel irritability were excluded from the study.
All patients were subjected to preoperative detailed medical history taking, emphasizing on medical and surgical history, history of neurological disorders and spinal surgery, history of general disease e.g. diabetes mellitus and history of drug intake affecting the bowel functions .Also general examination including vital signs measuring and obstetrical examination.
All patients received spinal anesthesia and were operated by the same surgeon. In the control group, both the visceral and parietal peritoneum was closed, whereas in the experimental group both peritoneal layers were left unsutured. The time of skin incision and surgery end time were recorded.
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All patients were subjected to the follow up within the 1st 24 hours every six hours during postoperative stay in the hospital to be followed up regarding degree of pain, post operative distension ,temperature, regain of bowel functions assessed by auscultation of intestinal sounds and passage of flatus and Hb and hematocrit levels of all patients were assessed prior and 12 hours following operation and the reduction of postoperative hematocrit up to 3 - 4% less than preoperative values was considered as bleeding.
No significant differences were noted between the study groups with respect to age, parity, gestational age and reasons for CS.
The non-closure group was associated with significant shorter duration of surgery, significantly lower pain score compared to traditional practice (closure of the peritoneum).
The operative time was shorter (5.6 minutes) in the non-closure group than the closure group. Also there were short duration post operative hospital stay.
There was no significant difference between the two groups regarding postoperative febrile morbidity and difference between pre- and post-operative Hb level
Bowel function took longer time to return to normal after closure of the peritoneum compared with non-closure.
There was a significant statistical difference regarding incidence of distension as the non closure group showed less incidence of distension compared to the closure group.