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 questioned."

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 othe
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1-Aug-2005