Sezaryen keside parietal periton kapatılmasının postoperatif iyileşme üzerine etkisi: Prospektif gözlemsel çalışma
Öz
Amaç: Sezaryen doğum, obstetride en sık uygulanan cerrahi girişimlerden biridir. Postoperatif dönemde
erken fonksiyonel iyileşmenin desteklenmesi, anne sağlığı ve sağlık hizmetlerinin etkinliği açısından
kritik öneme sahiptir. Bu çalışma, sezaryende parietal periton kapatılmasının kısa dönem postoperatif
iyileşme üzerindeki etkilerini araştırmayı amaçlamaktadır.
Gereç ve Yöntem: Bu prospektif gözlemsel çalışmaya, 15 Ocak–15 Haziran 2025 tarihleri arasında spinal anestezi altında elektif koşullarda sezaryen uygulanan, 18–45 yaş aralığındaki kadınlar dahil edilmiştir. Acil sezaryenler, genel anestezi uygulananlar ve yüksek riskli gebelikler dışlanmıştır. Postoperatif iyileşme; EQ-5D Yaşam Kalitesi Ölçeği, Katz Günlük Yaşam Aktiviteleri İndeksi ve Obstetric Quality of Recovery (ObsQoR) skoru ile multidisipliner biçimde değerlendirilmiştir. Ayrıca ağrı skorları, gastrointestinal fonksiyonların geri dönüşü, ek analjezik gereksinimi ve hematolojik parametreler (NLR, PLR) karşılaştırılmıştır.
Bulgular: Çalışmaya toplam 120 olgu alınmış olup, 60’ı periton kapatma, 60’ı kapatmama grubunda yer almıştır. Parietal periton kapatma grubunda postoperatif 5. günde EQ-5D skorları anlamlı düzeyde daha yüksek bulunmuştur (p < 0.05). Bunun dışında ağrı skorları, bağırsak fonksiyonlarının geri dönüşü, analjezik ihtiyacı ve hematolojik parametreler (NLR, PLR) açısından gruplar arasında istatistiksel olarak anlamlı fark saptanmamıştır.
Sonuç: Bulgular, erken yaşama dönüş ve inflamatuvar belirteçler dikkate alındığında, rutin parietal periton kapatılmasının kısa dönem postoperatif iyileşmeye ek bir katkı sağlamadığını göstermektedir. Bu nedenle kapatma kararının rutin uygulamadan ziyade cerrahın tercihine ve klinik koşullara göre verilmesi daha uygun görünmektedir.
Anahtar Kelimeler
Kaynakça
- Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.
- Kerr JMM. The technic of cesarean section, with special reference to the lower uterine segment incision. Am J Obstet Gynecol [Internet]. 1926;12(5):729–34. Available from: https://www.sciencedirect.com/science/article/pii/S0002937826903761
- Bamigboye AA, Hofmeyr GJ. Closure versus non-closure of the peritoneum at caesarean section: short- and long-term outcomes. Cochrane database Syst Rev. 2014 Aug;2014(8):CD000163.
- Ghongdemath JS, Banale SB. A randomized study comparing non-closure and closure of visceral and parietal peritoneum during cesarean section. Vol. 61, Journal of Obstetrics and Gynaecology of India. 2011. p. 48–52.
- Struller F, Weinreich FJ, Horvath P, Kokkalis MK, Beckert S, Königsrainer A, et al. Peritoneal innervation: embryology and functional anatomy. Pleura and peritoneum. 2017 Dec;2(4):153–61.
- Weerawetwat W, Buranawanich S, Kanawong M. Closure vs non-closure of the visceral and parietal peritoneum at cesarean delivery: 16 year study. J Med Assoc Thai. 2004 Sep;87(9):1007–11.
- Kahyaoğlu Süt H, Unsar S. Is EQ-5D a valid quality of life instrument in patients with acute coronary syndrome? Anadolu Kardiyol Derg. 2011 Mar;11(2):156–62.
- Arik G, Varan HD, Yavuz BB, Karabulut E, Kara O, Kilic MK, et al. Validation of Katz index of independence in 106 Ege Journal of Medicine / Ege Tıp Dergisi activities of daily living in Turkish older adults. Arch Gerontol Geriatr. 2015;61(3):344–50.
- Ozkan G, Kara U, Ince ME, Ozdemir O, Ulubay M, Senkal S. Validation of the Turkish version of the Obstetric Quality-of-Recovery score 11 (ObsQoR-11T) after cesarean delivery. Health Qual Life Outcomes. 2022 Nov;20(1):155.
- Zareian Z, Zareian P. Non-closure versus closure of peritoneum during cesarean section: a randomized study. Eur J Obstet Gynecol Reprod Biol. 2006;128(1–2):267–9.
- Anteby EY, Kruchkovich J, Kapustian V, Gdalevich M, Shenhav S, Gemer O. Short-term effects of closure versus non-closure of the visceral and parietal peritoneum at cesarean section: a prospective randomized study. J Obstet Gynaecol Res. 2009 Dec;35(6):1026–30.
- Hofmeyr GJ, Mathai M, Shah A, Novikova N. Techniques for caesarean section. Cochrane database Syst Rev. 2008 Jan;2008(1):CD004662.
- Gemer O, Kruchkovich J, Kapustian V, Gdalevich M, Shenhav S, Volach V, et al. Short term effects of peritoneal closure at cesarean section: Results of a randomized controlled trial. Am J Obstet Gynecol [Internet]. 2006 Dec 1;195(6):S111.
- Prabhu, S., Prasad, D. N., Mishra, N., Jadhav, V., & Savani, G. (2021). A prospective randomized controlled study comparing short-term outcomes of closure and non-closure of peritoneum during elective caesarean section. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 10(7), 2656–2661.
- Altinbas SK, Cenksoy P, Tapisiz OL, Beydilli G, Yirci B, Ercan Ö, et al. Parietal peritoneal closure versus non-closure at caesarean section: which technique is feasible to perform? J Matern neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2013 Jul;26(11):1128–31.
- Tabasi Z, Mahdian M, Abedzadeh-Kalahroudi M. Closure or non-closure of peritoneum in cesarean section: outcomes of short-term complications. Arch trauma Res. 2013;1(4):176–9.
- Alsabani MH, Alenezi FK, Alotaibi BA, Alotaibi AA, Olayan LH, Aljurais SF, et al. Ratios of Neutrophils and Platelets to Lymphocytes as Predictors of Postoperative Intensive Care Unit Admission and Length of Stay in Bariatric Surgery Patients: A Retrospective Study. Medicina (Kaunas). 2024 Apr;60(5).
- Ketenci Gencer F, Yüksel S. Can Neutrophil-to-lymphocyte Ratio and Platelet-tolymphocyte Ratio be Used as Inflammatory Markers to Predict Length of Hospital Stay After Total Laparoscopic Hysterectomy for Benign Indications? J Acad Res Med. 2022;12(3):108–15.
- Tzikos G, Alexiou I, Tsagkaropoulos S, Menni AE, Chatziantoniou G, Doutsini S, et al. Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Predictive Factors for Mortality and Length of Hospital Stay after Cardiac Surgery. J Pers Med. 2023 Mar;13(3).
- Cheong YC, Premkumar G, Metwally M, Peacock JL, Li TC. To close or not to close? A systematic review and a meta-analysis of peritoneal non-closure and adhesion formation after caesarean section. Eur J Obstet Gynecol Reprod Biol. 2009 Nov;147(1):3–8.
The impact of parietal peritoneal closure on postoperative recovery following cesarean section: A prospective observational study
Öz
Aim: Caesarean section is one of the most frequently performed surgical procedures in obstetrics.
Supporting early functional recovery in the postoperative period is of critical importance for maternal
health and healthcare efficiency. This study aimed to investigate the short-term effects of parietal
peritoneal closure on postoperative recovery following caesarean delivery.
Materials and Methods: This prospective observational study included women aged 18–45 years who
underwent elective caesarean section under spinal anesthesia between January 15 and June 15, 2025.
Emergency cases, procedures performed under general anesthesia, and high-risk pregnancies were
excluded. Postoperative recovery was evaluated multidimensionally using the EQ-5D Quality of Life
Scale, the Katz Index of Independence in Activities of Daily Living, and the Obstetric Quality of Recovery
(ObsQoR) score. Additional outcomes included pain scores, return of gastrointestinal function,
requirement for additional analgesics, and hematological parameters (NLR, PLR).
Results: A total of 120 women were enrolled, with 60 in the peritoneal closure group and 60 in the nonclosure
group. On postoperative day 5, EQ-5D scores were significantly higher in the closure group (p
< 0.05). No statistically significant differences were observed between groups in terms of pain intensity,
gastrointestinal recovery, additional analgesic requirement, or hematological parameters (NLR, PLR).
Conclusion: The findings suggest that routine parietal peritoneal closure does not provide additional
benefits for short-term postoperative recovery when considering early return to daily activities and
inflammatory markers. Therefore, the decision to close the peritoneum may be better guided by surgical
preference and intraoperative conditions rather than routine practice.
Anahtar Kelimeler
Etik Beyan
This study was approved by the institutional ethics committee, and all procedures were conducted in accordance with the principles of the Declaration of Helsinki. Written informed consent was obtained from all participants included in the study.
Destekleyen Kurum
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Teşekkür
The authors declare that no acknowledgements are applicable, as no specific support or contribution was received for this study.
Kaynakça
- Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR. The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343.
- Kerr JMM. The technic of cesarean section, with special reference to the lower uterine segment incision. Am J Obstet Gynecol [Internet]. 1926;12(5):729–34. Available from: https://www.sciencedirect.com/science/article/pii/S0002937826903761
- Bamigboye AA, Hofmeyr GJ. Closure versus non-closure of the peritoneum at caesarean section: short- and long-term outcomes. Cochrane database Syst Rev. 2014 Aug;2014(8):CD000163.
- Ghongdemath JS, Banale SB. A randomized study comparing non-closure and closure of visceral and parietal peritoneum during cesarean section. Vol. 61, Journal of Obstetrics and Gynaecology of India. 2011. p. 48–52.
- Struller F, Weinreich FJ, Horvath P, Kokkalis MK, Beckert S, Königsrainer A, et al. Peritoneal innervation: embryology and functional anatomy. Pleura and peritoneum. 2017 Dec;2(4):153–61.
- Weerawetwat W, Buranawanich S, Kanawong M. Closure vs non-closure of the visceral and parietal peritoneum at cesarean delivery: 16 year study. J Med Assoc Thai. 2004 Sep;87(9):1007–11.
- Kahyaoğlu Süt H, Unsar S. Is EQ-5D a valid quality of life instrument in patients with acute coronary syndrome? Anadolu Kardiyol Derg. 2011 Mar;11(2):156–62.
- Arik G, Varan HD, Yavuz BB, Karabulut E, Kara O, Kilic MK, et al. Validation of Katz index of independence in 106 Ege Journal of Medicine / Ege Tıp Dergisi activities of daily living in Turkish older adults. Arch Gerontol Geriatr. 2015;61(3):344–50.
- Ozkan G, Kara U, Ince ME, Ozdemir O, Ulubay M, Senkal S. Validation of the Turkish version of the Obstetric Quality-of-Recovery score 11 (ObsQoR-11T) after cesarean delivery. Health Qual Life Outcomes. 2022 Nov;20(1):155.
- Zareian Z, Zareian P. Non-closure versus closure of peritoneum during cesarean section: a randomized study. Eur J Obstet Gynecol Reprod Biol. 2006;128(1–2):267–9.
- Anteby EY, Kruchkovich J, Kapustian V, Gdalevich M, Shenhav S, Gemer O. Short-term effects of closure versus non-closure of the visceral and parietal peritoneum at cesarean section: a prospective randomized study. J Obstet Gynaecol Res. 2009 Dec;35(6):1026–30.
- Hofmeyr GJ, Mathai M, Shah A, Novikova N. Techniques for caesarean section. Cochrane database Syst Rev. 2008 Jan;2008(1):CD004662.
- Gemer O, Kruchkovich J, Kapustian V, Gdalevich M, Shenhav S, Volach V, et al. Short term effects of peritoneal closure at cesarean section: Results of a randomized controlled trial. Am J Obstet Gynecol [Internet]. 2006 Dec 1;195(6):S111.
- Prabhu, S., Prasad, D. N., Mishra, N., Jadhav, V., & Savani, G. (2021). A prospective randomized controlled study comparing short-term outcomes of closure and non-closure of peritoneum during elective caesarean section. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 10(7), 2656–2661.
- Altinbas SK, Cenksoy P, Tapisiz OL, Beydilli G, Yirci B, Ercan Ö, et al. Parietal peritoneal closure versus non-closure at caesarean section: which technique is feasible to perform? J Matern neonatal Med Off J Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet. 2013 Jul;26(11):1128–31.
- Tabasi Z, Mahdian M, Abedzadeh-Kalahroudi M. Closure or non-closure of peritoneum in cesarean section: outcomes of short-term complications. Arch trauma Res. 2013;1(4):176–9.
- Alsabani MH, Alenezi FK, Alotaibi BA, Alotaibi AA, Olayan LH, Aljurais SF, et al. Ratios of Neutrophils and Platelets to Lymphocytes as Predictors of Postoperative Intensive Care Unit Admission and Length of Stay in Bariatric Surgery Patients: A Retrospective Study. Medicina (Kaunas). 2024 Apr;60(5).
- Ketenci Gencer F, Yüksel S. Can Neutrophil-to-lymphocyte Ratio and Platelet-tolymphocyte Ratio be Used as Inflammatory Markers to Predict Length of Hospital Stay After Total Laparoscopic Hysterectomy for Benign Indications? J Acad Res Med. 2022;12(3):108–15.
- Tzikos G, Alexiou I, Tsagkaropoulos S, Menni AE, Chatziantoniou G, Doutsini S, et al. Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Predictive Factors for Mortality and Length of Hospital Stay after Cardiac Surgery. J Pers Med. 2023 Mar;13(3).
- Cheong YC, Premkumar G, Metwally M, Peacock JL, Li TC. To close or not to close? A systematic review and a meta-analysis of peritoneal non-closure and adhesion formation after caesarean section. Eur J Obstet Gynecol Reprod Biol. 2009 Nov;147(1):3–8.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Kadın Hastalıkları ve Doğum |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Gönderilme Tarihi | 26 Ağustos 2025 |
| Kabul Tarihi | 20 Kasım 2025 |
| Yayımlanma Tarihi | 9 Mart 2026 |
| DOI | https://doi.org/10.19161/etd.1772256 |
| IZ | https://izlik.org/JA23NG78JS |
| Yayımlandığı Sayı | Yıl 2026 Cilt: 65 Sayı: 1 |
Kaynak Göster
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