Double-layer closure of uterine incision with visceral and parietal peritoneal closure: are they obligatory steps of routine cesarean sections?

The objective of this study was to examine the feasibility of a modified technique of cesarean section in which the uterine incision is sutured in one layer and the visceral and parietal peritoneum are left open. Two hundred patients undergoing a low segment cesarean section were prospectively randomized (according to the patients' identity numbers) into two groups. The first group had standard cesarean section including a continuous double layer closure of uterine incision in addition to closure of visceral and parietal peritoneum. The second group underwent the modified procedure as described above. The modified technique compared to the standard technique, resulted in shorter operative time (32 +/- 11 versus 44 +/- 16 min, P < 0.0001) and a reduced need for postoperative sedation (P < 0.004). The operative procedure was shown, by multiple regression analysis, to be the significant factor that determined its length. Postoperative morbidity was similar in the two groups. The modified technique of cesarean section reduces operative time and postoperative narcotic requirement, and has no adverse affect on postoperative recovery. A double-layer closure of low uterine incision, re-approximation of bladder flap, and closure of parietal peritoneum, as in the standard technique, do not seem to be essential steps of cesarean section. Larger studies are needed to ensure the safety of one-layer uterine closure in future deliveries.