{"paper_id":"347fa346-1839-446a-8737-5d08bd518ab3","body_text":"Submit Manuscript | http://medcraveonline.com\nIntroduction \nHysterectomy is one of the widely performed gynecological \nsurgeries. During closure of the abdomen, parietal peritoneum could \nbe closed or not .Whether the parietal peritoneum should be closed at \nhysterectomy or not is an argumental topic.1\nDifferent opinions regarding closure of parietal peritoneum set \nforth both views with the concept that defends closing peritoneum \nsuggests that any incised layer during operation must be stitched \nback so as to restore the anatomical picture back to normal possibly.2 \nPeritoneal healing and other serosal surfaces take place by metaplasia \nof the connective tissue underlying.3\nPeritoneum restores within 8 days post operatively. Some studies \nsupport non- closure of peritoneum while other researches support \nclosure of peritoneum.4\nIn non-peritoneal closure, future surgeries become difficult with \nlonger time. It could leads to complications as dyspareunia, long \nstanding pain, infertility, hernia and intestinal obstruction.5 \nThe concept of closing peritoneum is to retain of the abdominal \nstructures inside the abdomen. Closing the Peritoneal creates a barrier \nbetween abdominal structures and the anterior abdominal wall. \nThe non-closed peritoneum heals after 8 days post operatively, \nin non-closure of peritoneum, the adhesions might generate, with \nadhesion of the anterior abdominal wall to uterus, intestine and \nomentum. Less dense adhesions are noticed in parietal peritoneal \nclosure in primary cesarean sections.6\nAim of study \nTo assess the level of postoperative pain in women undergoing \nhysterectomy with closure of peritoneum versus non- closure of \nperitoneum.\nPatients and methods \nSetting: Badr University Hospital.\nStudy design: A prospective observational study.\nStudy population:  Women undergone abdominal hysterectomy at \nBadr University Hospital. Every women underwent an open abdominal \nsubtotal hysterectomy complaining from a benign endometrial lesion \n(Hyperplasia) or adenomyosis or fibroid uterus after endometrial \nBiopsy that revealed a benign endometrial pathology.\nEvery women received general anesthesia, with a Pfannenstiel \nincision was performed. The difference was in closure of parietal \nperitoneum in one group versus non closure of peritoneum in the other \ngroup.\nPatients divided into two groups according to peritoneal closure, \nGroup 1: parietal peritoneum was closed and \nGroup 2: the parietal peritoneum was left without closure which was \nwritten in the operative file of the patient.\nEvery women received a standard post-operative analgesia; in the \nform of one amp of intravenous nonsterodial anti-inflammatory drug \n(one amp ketolac) IV infusion and one bottle of perfalgan IV .\nPain was assessed postoperatively using Visual Analogue Score \nscale (V AS) (from 1-10) after 1 hour, 2 hours, 3 hours, 6 hours, 12 \nhours, 24 hours.\nEthical considerations\nLocal ethical committee approval was obtained before the study \nstart.\nResults \nIn the present study, there was no statistical difference between \nperitoneal closure and non-closure regarding age (Table 1).\nIn the present study, there was no statistical difference between \nperitoneal closure and non-closure regarding BMI (Table 2).\nIn the current research, there was no statistical difference between \nperitoneal closure and non-closure regarding gravidity and parity \n(Table 3).\nObstet Gynecol Int J. 2024;15(1):29‒31. 29\n©2024 Khedr et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which \npermits unrestricted use, distribution, and build upon your work non-commercially.\nEffect of peritoneal closure versus non closure after \nopen hysterectomy on postoperative pain\nVolume 15 Issue 1 - 2024\nAhmed Hassan Khedr,1 Y ossra Lasheen2 \n1Assistant professor of Obstetrics and Gynecology, Faculty of \nMedicine, Helwan University, Egypt\n2Assistant professor of Obstetrics and Gynecology, Kasralainy \nFaculty of Medicine, Cairo University, Egypt\nCorrespondence: Ahmed Hassan, Assistant Professor \nof Obstetrics & Gynecology, Faculty of Medicine, Helwan \nUniversity, Egypt, T el +966537019317, \nEmail \nReceived: February 05, 2024 | Published: February 16, 2024\nAbstract\nBackground: Hysterectomy is one of the widely performed gynecological surgeries. \nDuring closure of the abdomen, parietal peritoneum could be closed or not .Whether the \nparietal peritoneum should be closed at hysterectomy or not is an argumental topic.\nAim: To assess the level of postoperative pain in women undergoing hysterectomy with \nclosure of peritoneum versus non- closure of peritoneum.\nPatients and methods: A prospective observational study was conducted on women \nundergoing abdominal hysterectomy.\nResults: There was a statistically significant difference between the closures and non- \nclosure groups during hysterectomy regarding V AS after 2 hours, 3 hours and 6 hours, 12 \nhours and 24 hours with p value > 0.001.\nConclusion: Non closure of the peritoneum during abdominal hysterectomy was associated \nwith less operative time and less pain during the 2nd, 3rd, 6th, 12th and 24th hours after \nhysterectomy.\nKeywords: peritoneal closure, hysterectomy, postoperative pain, abdomen\nObstetrics & Gynecology International Journal \nResearch Article\n Open Access\n\n\nEffect of peritoneal closure versus non closure after open hysterectomy on postoperative pain\n30\nCopyright:\n©2024 Khedr et al.\nCitation: Khedr AH, Lasheen Y. Effect of peritoneal closure versus non closure after open hysterectomy on postoperative pain. Obstet Gynecol Int J. \n2024;15(1):29‒31. DOI: 10.15406/ogij.2024.15.00730\nT able 1 Shows baseline characteristics in the closure and non-closure groups\n Non closure (40) Closure (40) p-value \nAge 56.65=4.37 57.3=6.04 0.583\nBMI 28.51=3.98 29.410=3.90 0.313\nGravidity 0.184\n1 1 (2.5%) 1 (2.5%)\n2 6 (15.0%) 9 (22.5%)\n3 5 (12.5%) 13 (32.5%)\n4 7 (17.5%) 8 (20%)\n5 10 (25.0%) 5 (12.5%)\n6 6 (15.0%) 2 (5.0%)\n7 3 (7.5%) 2 (5.0%)\n8 2 (5.0%) 0\nParity 0.179\n1 1 (2.5%) 1 (2.5%)\n2 6 (15.0%) 10 (25.0%)\n3 7 (17.5%) 14 (35.0%)\n4 7 (17.5%) 6 (15.0%)\n5 10 (25.0%) 6 (15.0%)\n6 5 (12.5%) 3 (7.5%)\n7 4 (10%) 0  \nT able 2 Shows the difference between both groups regarding operative time\nOperative time 71.01=9.86 78.55=7.38 0.001>\nT able 3 Demonstrates the Visual Analogue Scale (VAS) after hysterectomy \nin both groups\n Non closure (40) Closure (40) p-value\nVAS scale one hour 9.18=0.64 9.35=0.53 0.186\nVAS scale 2 hours 7.2=1.07 7.95=0.96 >0.001\nVAS scale 3 hours 5.33=1.07 6.83=1.01 >0.001\nVAS scale 6 hours 3.85=1.1 5.71=0.99 >0.001\nVAS scale 12 hours 2.48=0.93 4.5=0.91 >0.001\nVAS scale 24 hours 1.6=0.71 2.93=0.92 >0.001\nDiscussion \nIn a previous study made by A. Takreem 2015, There was \nno noteworthy differences in both groups regarding immediate \npostoperative morbidity, postoperative pain, analgesics need, fever, \nwound healing and hospital stay. \nIn non-closure group, dense adhesions were seen during \nlaparotomies, Enterance to peritoneal cavity was more hard with \nlonger time. Adhesiolysis was required to reach the uterus, leading to \nlonger incision, time of surgery .Adhesions were more in the case of \nnon-closure group (p<0.05).7\nIn the current research, closure of the parietal peritoneum was \nassociated with higher mean operative time than the non- closure \ngroup with p value > 0.001.\nNon-closure of peritoneum might decrease the operative time \nby few minutes which draws many studies to promote non-closure \ntechnique.8\nA study made in Pakistan comparing peritoneal closure versus non-\nperitoneal closure of peritoneum noted that peritoneal nonclosure was \nsuggested as it decreases surgery time, span of anaesthesia, quicker \nrecovery and early hospital discharge.9\nIn the current research, there was no statistically significant \ndifference between the closures and non- closure groups during \nhysterectomy regarding V AS after one hour. Most of the researches \nwhich support non-closure of peritoneum, did not assess long term \ncomplications as adhesions in the following surgeries.10\nMoreover, in the current research, there was a statistically \nsignificant difference between the closure and non- closure groups \nduring hysterectomy regarding V AS after 2 hours, 3 hours and 6 hours \nwith p value > 0.001.\nA previous double blind randomized trial was performed to \nevaluate the intensity of post-caesarean pain between closure and non-\nclosure group reached hardly no difference in postoperative pain in \nboth groups in successive cesareans.11\nMoreover, in the current research, there was a statistically \nsignificant difference between the closure and non- closure groups \nduring hysterectomy regarding V AS after 12 hours and 24 hours with \np value > 0.001.\nIn a recent study, made by Igor Sirák et al., 11 on non-closure of \nperitoneum after abdominal hysterectomy for uterine carcinoma \ndoes not increase late intestinal radiation morbidity .Also, there is no \nsubsequent intestinal morbidity enhancement in these patients.12\nIn a recent study made by Wagdy M Amer, 12 they reported that \nvisceral and parietal peritoneum in CS, the non-closure approach \nis recommended due to its much shorter operating time and lower \npostoperative pain score. As a result of these advantages, it may be \npreferred as a method of treating CS patients.12\nConclusion \nNon closure of the peritoneum during abdominal hysterectomy \nwas associated with less operative time and less pain during the 2nd, \n3rd, 6th, 12 th and 24 th hours after hysterectomy.\nTo the best of our knowledge, our study is the first study to \ncompare the effect of closure versus non- closure of the peritoneum \nduring abdominal hysterectomy on post-operative pain.\nFuture studies with larger sample size are recommended on \nassessment of postoperative pain during hysterectomy with comparing \nclosure versus non- closure of the peritoneum. \nAcknowledgments\nNone.\nFunding \nNone.\nConflicts of interest \nAuthor declares that there is no conflict of interest.\nReferences\n1. Anjali C, Neeta B. Non closure of parietal peritoneum at cesarean \nsection and adhesion formation. Int Reprod Contracep Obstet Gynecol. \n2013;2(3):406–409.\n2. Bigatti G, Boeckx W, Gruft L. Experimental model for neoangiogenesis \nin adhesion formation. Human Reprod. 1995;10(9):2290–2294.\n3. Cheong YC, Laird SM, Shelton JB. To close or not to close? A systematic \nreview and a meta-analysis of peritoneal nonclosure and adhesion \nformation after caesarean section. Eur J Obstet Gynecol Reprod Biol . \n2009;147(1):3–8.\n\nEffect of peritoneal closure versus non closure after open hysterectomy on postoperative pain\n31\nCopyright:\n©2024 Khedr et al.\nCitation: Khedr AH, Lasheen Y. Effect of peritoneal closure versus non closure after open hysterectomy on postoperative pain. Obstet Gynecol Int J. \n2024;15(1):29‒31. DOI: 10.15406/ogij.2024.15.00730\n4. Di Zerega GS. Contemporary adhesion prevention. Fertil Steril . \n1994;61(2):219–235.\n5. Ellis H. The clinical significance of adhesions: Focus on intestinal \nobstruction. Eur J Surg Suppl. 1997;(577):5–9.\n6. Amera T. Comparison of peritoneal closure versus non-closure during \ncaesarean section. J Ayub Med Coll Abbottabad. 2015;27(1):78–80.\n7. Levrant SG, Bieber EJ. Anterior abdominal wall adhesions after \nlaparotomy or laparoscopy. J Am Assoc Gynecol Laparoscop . \n1995;4(3):353–356.\n8. Shakeel S. Peritoneal non-closure at caesarean section- A study of short \nterm post-operative morbidity. Pak Armed F Med J. 2008;30:9648.\n9. Lyell DJ, Chaughey AB, Daniels K. Peritoneal closure at primary \ncaesarean delivery and adhesions. Obstet Gynecol . 2005;106(2):275–\n280.\n10. Praveen K. Pathogenesis, consequences, and control of peritoneal \nadhesions in gynecologic surgery. Fertil Steril. 2008:144–149.\n11. Igor S, Marian K, Miroslav H, et al. Non-closure of peritoneum after \nabdominal hysterectomy  for uterine carcinoma does not increase \nlate intestinal  radiation morbidity. Rep Pract Oncol Radiother . \n2012;17(1):19–23.\n12. Wagdy M Amer, Ashraf I El-Mashad, Esraa M Abdel-Moaty, et al. \nEffects of closure versus non-closure of the visceral and parietal \nperitoneum at cesarean section. BMFJ. 2023;40(1):206–216.","source_license":"CC0","license_restricted":false}