Effect of Closure of Anterior Abdominal Wall Layers on Early Postoperative Findings at Cesarean Section: A Prospective Cross-sectional Study

Abstract Objective To investigate the effect of closure types of the anterior abdominal wall layers in cesarean section (CS) surgery on early postoperative findings. Methods The present study was designed as a prospective cross-sectional study and was conducted at a university hospital between October 2018 and February 2019. A total of 180 patients who underwent CS for various reasons were enrolled in the study. Each patient was randomly assigned to one of three groups: Both parietal peritoneum and rectus abdominis muscle left open (group 1), parietal peritoneum closure only (group 2), and closure of the parietal peritoneum and reapproximation of rectus muscle (group 3). All patients were compared in terms of postoperative pain scores (while lying down and duringmobilization), analgesia requirement, and return of bowel motility. Results The postoperative pain scores were similar at the 2nd, 6th, 12th, and 18th hours while lying down. During mobilization, the postoperative pain scores at 6 and 12 hours were significantly higher in group 2 than in group 3. Diclofenac use was significantly higher in patients in group 1 than in those in group 2. Meperidine requirements were similar among the groups. There was no difference between the groups’ first flatus and stool passage times. Conclusion In the group with only parietal peritoneum closure, the pain scores at the 6th and 12th hours were higher. Rectus abdominismuscle reapproximations were found not to increase the pain score. The closure of the anterior abdominal wall had no effect on the return of bowel motility.

摘要
目的：探讨剖宫产（cesarean section, CS）术中前腹壁各层闭合方式对术后早期临床转归的影响。
方法：本研究为前瞻性横断面研究，于2018年10月至2019年2月在某大学附属医院开展。共纳入180例因各类临床指征行剖宫产术的患者，按随机分配原则分为3组：组1为壁腹膜与腹直肌（rectus abdominis muscle）均保持开放状态，组2为仅缝合壁腹膜（parietal peritoneum），组3为缝合壁腹膜并行腹直肌复位缝合。比较各组患者术后静息与下床活动时疼痛评分、镇痛药物使用需求及肠道蠕动功能恢复情况。
结果：术后2、6、12、18小时静息状态下，各组疼痛评分无显著差异。下床活动时，组2术后6、12小时的疼痛评分显著高于组3。组1患者双氯芬酸（Diclofenac）的使用量显著高于组2，各组哌替啶（Meperidine）的使用需求无显著差异。各组首次排气、排便时间无统计学差异。
结论：仅行壁腹膜缝合的组2术后6、12小时疼痛评分更高；腹直肌复位缝合并未增加术后疼痛评分；前腹壁闭合方式对肠道蠕动功能恢复无显著影响。