| September 2007 · Vol. 19, No. 09 COMMENT & CONTROVERSY
Peritoneal closure at C-section reduces the risk of adhesions
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Fast Track
“Are we really doing the patient a favor when we save operative time by leaving the peritoneum open?”
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“Averting adhesions: Surgical techniques and tools,” by Togas Tulandi, MD, MHCM, and Mohammed Al-Sunaidi, MD
Even as Drs. Tulandi and Al-Sunaidi focus on ways to prevent adhesions, they assert that peritoneal closure is unnecessary. I disagree. The peritoneum is there for a reason: to separate the abdominal contents from the muscles and fascia. There are studies reporting more adhesions with closure, and studies reporting the opposite. Yet I have, on numerous occasions, entered directly into the amniotic sac while trying to separate the rectus muscles during repeat C-section. How did the uterine muscle become incorporated into the rectus muscles, with no plane of separation?
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