[Peritonealization in gynecologyand obstetrics--review of literature].

INTRODUCTION

Our purpose was to review the literature on the subject of peritoneal closure and to evaluate the advantages and disadvantages of this procedure.

EXPERIMENTAL STUDIES: Experimental studies have proved that peritoneal defects demonstrate mesothelial integrity (reperitonealization) 48-72 hours after injury and gross healing occurs within five days. A foreign body in the peritoneum causes tissue ischemia, necrosis, inflammation, and it stimulates numerous and dense adhesions. SURGERY (GENERAL AND GYNECOLOGICAL): The major advantage of peritoneal non-closure is a decreased adhesion formation, quicker return of bowel activity and reduced risk of bowel obstruction after surgery. Not only does peritoneal closure provide no immediate postoperative benefits, but it also prolongs surgical time, exposure to anesthesia and post-operative hospital stay unnecessarily, thus increasing surgery expenses. In summary, the existing data do not show advantages of this technique. Since many surgical tenets are based on limited data or opinion of the individual surgeons, they should be changed according to evidence-based medicine.

CONCLUSION

Therefore, we suggest that the traditional practice of peritoneal closure be abolished in gynecology and obstetrics. It is our strong wish to encourage clinicians not to close both parietal and visceral peritoneum.