Is peritoneal closure necessary?

Closure of peritoneal defects after laparotomy has long been considered a standard surgical procedure. In 1895 Smith wrote that "Sinister results which we seek to avoid, arise when we leave raw surfaces to which intestines may adhere and cause obstruction. To cover such a surface by peritoneum would, according to published statistics, save nearly 2 percent of the deaths after abdominal operation." (1). The purpose of this review is to reexamine the necessity of peritoneal closure in current medical practice. The argument for peritoneal closure includes the following: 1) restoration of anatomy and approximation of tissues for healing, 2) reestablish the peritoneal barrier to reduce the risk of infection, 3) reduce the risk of wound herniation or dehiscence, and 4) minimize adhesion formation. The argument against peritoneal closure involves the following: 1) nonclosure has not been observed to be detrimental, 2) without reapproximation the peritoneum heals rapidly, 3) suture presence and additional tissue handling may contribute to adhesion formation and 4) reduced surgical intervention and operating time is beneficial to the patient. This review will individually discuss these arguments and summarize their relative support.