Tendências Atuais em Oncologia Ginecológica

Abstrato

The closure non-closure of the parietal peritoneum in the caesarean section - Nejla Gultekin- Mersin City Hospital

Nejla Gultekin

Abstract: Cesarean area is the most normally performed medical procedure around the world. Ongoing occasions have seen increasing patterns in c-area rates, for an assortment of reasons. Despite the fact that the essential method stays same, some new procedures have been received like not shutting the instinctive or the parietal peritoneum. An enormous number of studies on benefits and negative marks of these practices have been distributed, creating considerably bigger discussions. Goal of this exertion is to assess concentrates on either side of the contention and refer to our experiences. Repeat cesarean segments were assessed for grip related procedural issues in both peritoneal conclusion and non-conclusion in essential cesareans. Thick bonds were seen in situations where peritoneal conclusion was not done in past medical procedure and there were less or less thick attachment situations where routine conclusion of parietal peritoneum was rehearsed. Routine conclusion of parietal peritoneum in cesarean segments is prescribed to diminish grip related dismalness and troublesome resulting medical procedure.

Introduction: The activity time caesarean area was influenced from the methods of the activity in the principal caesarean segment. Peritoneal conclusion is a significant stomach activity. Each really include arrangement of discrete cuts in the mother. The skin, fundamental muscle and mid-region are opened first and afterward uterus is opened permitting the expulsion of newborn child. This definition does exclude expulsion of a baby from the stomach depression in the instances of the break of the uterus or on account of 'a stomach pregnancy. Over the span of laparotomy, in any case kind of lower stomach cut utilized, blood, fibrin and tissue item from the area of the rectus muscles and front stomach divider access the pelvis. Hanging the edges of the entry point with a lap  wipe or towel preceding setting oneself holding retractor will forestall run-down of these adhesiogenic substances over the span of the activity yet in the event that the peritoneum isn't shut at the end of the system, entrance of these substances will probably happens in the initial scarcely any post-employable hours, until unconstrained scaling of the peritoneum happens.We freely close the peritoneum with fine (3.0) non-responsive absorbable stitch in all fruitlessness persistent and those patients in whom conservation of childbearing potential is alluring. That careful choice is empiric dependent on presumption Immediately after C/S the upper fundus and adnexa are stomach organs; along these lines any once-over into the pelvis would not likely influence the Fallopian cylinders and ovaries for a generous length of lime under standard conditions. Cesarean segment is the most widely recognized major surgery even a little lessening in post-employable inconveniences would majorly affect dreariness and would impact procedure for peritoneal conclusion. There is proof that if peritoneum left un-stitched, peritoneal deformity will have mesothelial trustworthiness inside 48 hours and afterward will be no Fibrosis or scar arrangement in five days. It was related with increasingly fast mending. The nonattendance of stitch materials and the decreased tissue taking care of is thought to add to a less bond development. Study focused on evaluation of the usable advantage and issue of peritoneal non conclusion at Cesarean Section.

Study design: This was a review study. The examination had two gatherings of the subsequent cesarean segments of patients who had conclusion and non-conclusion of parietal peritoneum in the principal cesarean area. The conclusion of parietal peritoneum was control bunch with 1308 patients and the non-conclusion of any peritoneum was case bunch with 740 patients. In the two gatherings, the activity time and the measure of the bonds of the omentum to the scarpa belt were looked at. A randomized controlled investigation of ladies experiencing CS was completed in Maternity and Pediatric educating medical clinic  in Najaf which is a tertiary level referral place including period between the first of Dec.2001 and 30th of Oct. 2002. 80 ladies were enrolled from the work ward. They were randomized to one of 2 gatherings 40 to peritoneal conclusion and 40 to non-conclusion of the peritoneum each gathering comprise of 20 demure gravida and 20 multiparous ladies. All ladies had essential CS and no past laparotomy and all done by similar people. Gathering An after conclusion of the uterus the typical way, the parietal and instinctive peritoneum was shut utilizing 1.0 chromic cut gut stitch. Stomach divider

Result: The non-conclusion of the parietal peritoneum may pick up time during the primary activity yet the non-conclusion will make the more bonds of omentum the scarpa belt and the time rehashed cesarean will be longer. Therefore, the recoup in second activity will be late in non-conclusion patients. The conclusion of peritoneal imperfection even with negligibly receptive stitch material outcome in tissue ischemia, necrosis, inflammation increment tissue response notwithstanding expanded tissue response and increment tissue taking care of, tissue injury and increment the usable time in relationship with conclusion all brought about expanded post employable grimness. Non conclusion seems to have not many risks.5 But the thing that matters was factually inconsequential (P>O.05) and this might be credited to the little example size and this finding was not in agreementwith Grundsell et al in there randomized controlled preliminary, revealed that febrile horribleness' and wound disease were essentially lower in the non closuregroup (P< (0.001) and (P < 0.05) individually.

Conclusion: This investigation was significant trial about activity strategies for doing the second activity to similar patients. This investigation ought to be done in various focuses with progressively number of patients in the World. This examination shows that non-conclusion of the peritoneum at cesarean segment is related with diminished activity lime which thusly lessens the sedative introduction. It has additionally demonstrated that non-conclusion of the peritoneum isn't related with expanded grimness. Study shows that non-closure of the peritoneum at cesarean section is associated with reduced operation lime which in turn reduces the anesthetic exposure. It has further proven that non-closure of the peritoneum is not associated with increased morbidity.