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Common Caesarian-Section Method Leads To Unnecessary Scars

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  • tarnishedsilverheart
    Common Caesarian-Section Method Leads To Unnecessary Scars STANFORD, CA -- August 1, 2005 -- A controversial surgical procedure that has lost favor among
    Message 1 of 1 , Aug 5, 2005
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      Common Caesarian-Section Method Leads To Unnecessary Scars
      STANFORD, CA -- August 1, 2005 -- A controversial surgical procedure
      that has lost favor among medical professionals may benefit women who
      have had caesarean sections. So say researchers at the Stanford
      University School of Medicine, who have found that closing the
      parietal peritoneum, a multi-layered membrane that lines the abdomino-
      pelvic walls, substantially decreases the likelihood of scarring that
      can make future C-sections more difficult.

      The finding on this link between peritoneum closure and fewer
      adhesions (scars that form abnormal connections between two parts of
      the body) runs contrary to current literature on the drawbacks of the
      procedure in non-pregnant women and contrary to current thinking
      among many surgeons.

      "This was a surprise finding," said Deirdre Lyell, MD, assistant
      professor of obstetrics and gynecology and lead author of a paper
      appearing in the August issue of Obstetrics and Gynecology. "We were
      fully expecting to find that closing the peritoneum at caesarean
      delivery would increase adhesions."

      More than 1 million caesareans - just over 27 percent of all births
      in the United States-are performed each year. However, Lyell said
      there is a lack of literature on the long-term impact of various
      parts of the procedure, including the closure of a woman's peritoneum
      following delivery. When c-sections are performed, surgeons must cut
      through the parietal peritoneum layer. The question plaguing Lyell
      was whether it is better to close it at the end of the caesarean or
      allow the membrane to heal on its own.

      "There is surprisingly little data on the best way to perform c-
      sections," said Lyell, who is also part of the Johnson Center for
      Pregnancy and Newborn Services at Lucile Packard Children's Hospital.

      Although the tradition had been to close the peritoneum following
      delivery, recent short-term studies have linked such closures with
      increased operation time and postoperative pain. There has also been
      concern that closure of the peritoneum at caesarean may lead to
      adhesions-which can cause problems such as bowel obstruction, chronic
      pelvic pain and infertility, and can make future surgeries longer and
      more difficult-though such a connection lacks sufficient supporting

      Because it is increasingly common for women to have repeat
      caesareans, Lyell said adhesions are of particular concern to this
      group of patients. She said the majority of surgeons don't close the
      parietal peritoneum; in Lyell's study, 60 percent of surgeons left
      the peritoneum open.

      Eager to gather more information, Lyell and her colleagues launched a
      study involving 173 women at Stanford who were undergoing a repeat
      caesarean. During the study, surgeons were asked after surgery to
      score the severity and location of any adhesions. The researchers
      then examined patient records to determine whether a participant's
      first caesarean included peritoneal closure; it had for about 39
      percent of the women.

      The researchers found that patients whose peritoneum was surgically
      closed following their first delivery were significantly less likely
      to have developed abdominal adhesions: 52 percent of patients with
      prior closure had adhesions versus 73 percent of non-closure
      patients. When controlling for potential confounding variables, the
      researchers determined that closing the peritoneum offered five times
      as much protection against the formation of adhesions as leaving it
      open. It also offered three times as much protection against dense
      adhesions, which are considered the most difficult to treat.

      Based on the results, the authors noted that "the practice of non-
      closure of the parietal peritoneum at caesarean delivery should be

      Lyell said the results, which differ from findings in studies on non-
      caesarean surgeries, also show that surgeons cannot rely on data from
      non-pregnant patients. "We shouldn't simply extrapolate what we know
      about others to pregnant women," said Lyell. "The patients are
      different; they have different physiology, and labor creates a unique

      While recommending closure of the peritoneum following caesarean
      delivery, Lyell cautioned that this study shouldn't be taken as the
      definitive answer on the procedure. More data is needed, she said,
      and a randomized clinical trial is warranted.

      Lyell's co-authors on the study include Stanford's Kay Daniels, MD;
      and Aaron Caughey, MD, and Emily Hu, MD, both at the University of
      California-San Francisco.

      SOURCE: Stanford University


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