Peritoneal adhesion prevention at cesarean section: an analysis of the effectiveness of an absorbable adhesion barrier.

摘要

OBJECTIVE: To evaluate the effectiveness of an absorbable adhesion barrier utilized at cesarean delivery. STUDY DESIGN: We performed a retrospective, two-arm cohort, chart review of primary and subsequent first repeat cesarean sections from January 1, 2006-December 31, 2009. Exclusion criteria were incomplete operative report, history of prior abdominal-pelvic surgery, pelvic inflammatory disease, chorioamnionitis, emergency cesarean delivery or use of corticosteroids within 2 weeks. Adhesion incidence/severity as well as skin incision to newborn delivery times were analyzed. Effects of peritoneal closure and suture types were examined. RESULTS: Of 262 primary cesareans performed, 43% (N= 112) had repeat cesarean section. With barrier, 74% had no adhesions at repeat surgery, versus 22% in the no barrier group (p = 0.011). Eleven percent had grade 2 adhesions with barrier, while 64% had grade 2-3 in the no barrier group (p = 0.012). The barrier group had no grade 3 adhesions. Those with parietal peritoneal closure had less incidence (p = 0.02) and mean adhesion severity (p = 0.03); no significant difference was found per suture type. No statistical difference in time from skin incision to newborn delivery was noted between primary and barrier group (p = 0.006); those without barrier had a statistically longer delivery interval (p = 0.35). CONCLUSION: Use of an absorbable adhesion baooorrier reduces the incidence and severity of adhesions at cesarean.