***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: This study describes a prospect i ve r and omized controlled trial to evaluate whether suture of the peritoneal layer is necessary as a separate step in the closure of midline abdominal surgical wounds . Consecutive patients undergoing abdominal operation — elective and emergency surgery — through a midline abdominal wound were r and omized to have the peritoneal layer closed with continuous catgut , or to have this step omitted . The linea alba was closed with interrupted stainless steel sutures , and the skin approximated with staples . Patients were evaluated for wound sepsis , wound dehiscence , and subsequent incisional hernia development . Postoperative pain was assessed by a self-administered visual analogue score , and by measuring narcotic requirements . There was no significant difference in narcotic requirements , pain scores , or wound complications between the 2 groups . Single-layer closure of the abdominal wall is quicker , less costly , and theoretically safer than layered closure , and it is recommended that separate suture of the peritoneum be ab and oned . ResuméDans cette étude prospect i ve , r and omisée , et contrôlée , nous avons cherché à savoir si la fermeture individualisée du péritoine était nécessaire dans la fermeture d'une laparotomie médiane . Deux cents patients consécutifs — opérés à froid ou en urgence — par laparotomie médiane  , ont été r and omisés : dans un groupe , le péritoine a été fermé en un plan individualisé par un surjet au catgut , dans l'autre , le péritoine n'a pas été suturé . La ligne blanche a été fermée en un plan par des points séparés de fils d'acier ; la peau a été fermée par des agrafes . On a étudié le nombre des abcès de paroi , des éviscérations , et , à distance , des éventrations . La douleur postopératoire a été évaluée par un score analogue visuel , établi par le patient lui-même , ainsi que par la nécessité d'utiliser des antalgiques . Il n'y avait pas de différence significative entre les 2 groupes en ce qui concerne le taux de complications pariétales ou l'existence de douleur . Comme la fermeture pariétale en un seul plan est plus rapide , coûte moins cher , et , est théoriquement plus sûre ( on peut surveiller le contenu intrapéritonéal pendant la fermeture ) que la fermeture plan par plan , nous recomm and ons d'ab and oner la fermeture individualisée du péritoine . ResumenEl presente articulo describe un ensayo clínico prospect ivo destinado a investigar si es necesaria la sutura de la capa peritoneal como un paso independiente en el cierre de incisiones abdominales de línea media . Una serie de pacientes consecutivos sometidos a operaciones abdominales fueron r and omizados a cierre peritoneal con sutura continua de catgut  o a omisión de este paso . La línea alba fue cerrada con suturas interrumpidas de acero inoxidable y la piel con agrafes . Se estudió la incidencia de infección de herida , de dehiscencia , y de desarrollo de hernia incisional subsiguientes . La valoración del dolor postoperatorio fue realizada mediante autoevaluación con una escala linear análoga y la determinación de los requerimientos de narcóticos . No se encontraron diferencias significativas en el requerimiento de narcóticos para analgesia , en el nivel de la escala de dolor , o en la tasa de complicaciones entre los 2 grupos . El cierre de la pared abdominal en una capa única es más rápido , menos costoso , y teóricamente más seguro ; por lo tanto , se recomienda ab and onar la sutura del peritoneo The lateral paramedian incision has been advocated as the strongest incision for abdominal surgery . We have evaluated this incision and tested the necessity for closing the deep peritoneal layer by a prospect i ve r and omized trial . All 206 patients undergoing laparotomy in the Surgical Unit in 1984 , both elective and emergency cases , were included . In patients undergoing laparotomy through unscarred tissue , a lateral paramedian incision was performed and they were r and omized to have either the peritoneum closed ( n = 77 ) or left open ( n = 75 ) . Patients in whom the laparotomy was performed through a previous incision ( n = 51 ) and those in whom the abdomen had to be opened urgently ( n =3 ) were excluded from the trial but studied separately ( n = 54 ) . The rectus sheath was closed with monofilament nylon in all cases . Patients were assessed for wound integrity during the immediate postoperative period and at 1 , 3 , 6 and 12 months after operation . So far the patients have been followed up for between 1 and 2 years and follow‐up is continuing as in some cases incisional hernia may not be detected until several years after operation . There have been no cases of burst abdomen . No incisional hernias have developed in patients in whom a lateral paramedian incision was performed and the peritoneum was closed , and one incisional hernia has occurred in the patients in whom the peritoneum was left open . Seven incisional hernias have occurred in patients excluded from the trial of the lateral paramedian incision ( 13 per cent ) . We conclude that the lateral paramedian incision successfully abolishes the burst abdomen and that incisional hernia is rare . It is not necessary to close the peritoneum with this incision The effects of pelvic and periaortic peritoneal closure or ( non-closure ) on morbidity and adhesion formation were prospect ively compared in 102 patients with ovarian cancer who had undergone a pelvic and periaortic lymphadenectomy .  Hysterectomy with bilateral salpingoophorectomy , bilateral pelvic and periaortic lymphadenectomy , omentectomy , appendectomy and lysis of pelvic adhesions for the st and ardization of initial adhesion scores was performed on all patients . The pelvic and periaortic peritoneum were re-approximated in group I ( n = 50 ) patients , and left open in group II ( n = 52 ) patients . The groups were similar for mean age , previous surgery , tumour histology and disease stage . Morbidity characteristics such as blood loss , transfusion rate , post-operative infectious and non-infectious complications , and total hospital stay were also similar . After six courses of PAC ( cisplatin 50 mg/m(2 ) , Adriamycin 50 mg/m(2 ) , cyclophosphamide 500 Mg/M(2 ) ) chemotherapy , all patients underwent a second-look laparotomy . Persistent cancer was detected in 49 of 102 ( 48.03 % ) patients . Adhesion scores were detected at the time of second-look laparotomy . Adhesion scores for group I ( 8.9 + /- 2.9 ) were significantly higher than the group II ( peritoneum non-closure ) ( 5.8 + /- 2.3 ) ( P<0.01 ) . Closing the pelvic and periaortic peritoneum did not effect morbidity , but leaving the pelvic and periaortic peritoneum open significantly decreased the adhesion formation BACKGROUND The advantages of non-closure of the visceral and parietal peritoneum at lower segment cesarean section seems to be evident but in the reports published so far , the number of patients studied has been relatively small and the follow-up periods short . It is obviously of value to reconfirm such important observation in several institutions and therefore , in 1991 , we decided to study non-closure of the peritoneum in lower segment cesarean section in a large series of patients with long-term follow-up of at least one year . METHODS A prospect i ve r and omized study of 361 patients undergoing lower segment cesarean section in a University Affiliated Hospital , Al-Ain , United Arab Emirates . The operative technique was r and omized to include either non-closure of both visceral and parietal peritoneum ( study group , n = 179 ) or closure of both layers ( control group , n = 182 ) . Patients were followed up according to a study protocol . The nursing staff and the obstetricians responsible for data collection were unaware as to which of the two groups the patients belonged to . Student-t test and Chi-square test were used for statistical analysis of the results , where appropriate , with a p < 0.05 considered probability level to reflect significant differences . RESULTS Postoperative febrile morbidity and wound infection were significantly lower in the study group as compared to the control group ( p < 0.001 and p < 0.05 respectively ) . The incidence of wound dehiscence , urinary tract infection and the time to opening of the bowels postoperatively were similar in the two groups . In the non-closure group , the average operating time was significantly shorter by 7.9 minutes ( p < 0.01 ) and the hospital stay was one day less ( p < 0.01 ) . There were no patients with late postoperative complications or readmissions during 2 - 5 years of follow-up that could be attributed to complications associated with lower segment cesarean section . CONCLUSION Non-closure of the visceral and parietal peritoneum at lower segment cesarean section is associated with fewer postoperative complications , is more cost effective and is simpler than the traditional operative technique of closing both peritoneal layers OBJECTIVE To assess the benefits or problems that may be associated with peritoneal closure at cesarean section . METHODS A r and omized-controlled study of women undergoing cesarean section in Sultan Qaboos University Hospital Maternity Unit . After the decision is taken for cesarean section , women were r and omized to either repair of peritoneum using st and ard technique or non-repair of peritoneum .  Duration of operation , maternal morbidity , blood loss assessed by post-operative hemoglobin change and requirement of transfusion , post operative infection , thromboembolic disease , and length of hospital stay were analyzed in 2 groups of patients . Sixty women were r and omized into the study , 30 group A , had peritoneal closure and 30 , group B , and had non-closure .  RESULTS The average duration of operation for group A was 61.9+/-12.734 , and for group B was 53.56 + /-11.209 ( p < 0.01 statistically significant ) . There was no statistically significant difference in the length of stay , estimated blood loss , the mean drop in hemoglobin , postoperative pyrexia , and wound infection rate between the 2 groups . CONCLUSIONS Our study has confirmed the previous study findings , and has shown that there are no advantages in suturing of the peritoneum in terms of blood loss , blood transfusion , operation duration , postoperative pyrexia and wound infection . In fact non-suturing of the peritoneum was associated with shorter operation duration ( p < 0.01 significant ) , and reduced cost Closure of vertical laparotomy wounds was r and omized between a two‐layer technique of continuous catgut to peritoneum and continuous nylon to sheath and a one‐layer technique in which the peritoneal suture line was omitted . In 162 two‐layer closures there were 4 burst abdomens and 7 wound hernias ( 6·8 per cent wound failures ) ; in 164 one‐layer closures there were 5 burst abdomens and 7 hernias ( 7·3 per cent failures ) . Of 21 patients in this series with jaundice  , the abdominal wounds dehisced in 3 , and 4 patients developed incisional hernias ( 33·3 per cent failures ) compared with a 5·2 per cent failure rate in the 305 non‐jaundiced patients ( P < 0·01 ) The effect of visceral peritoneal closure after  conventional abdominal hysterectomies and Wertheim-Meigs radical operations  was studied clinical ly . No considerable differences were found in the postoperative staying period ; however , the incidence of complications were less in the  peritoneal non-closure group ( n = 91 ) than in the control , peritonealized group ( n = 149 ) . Significantly lower was the number of postoperative irregular pyelogram in cases without peritoneal closure ( n = 25 ) of radical abdominal operations than in the control group ( n = 49 ) with peritoneal suturing . We therefore suggest that the lack of suturing of visceral peritoneums has some advantages after  abdominal hysterectomies  and especially has benefits for Wertheim-Meigs operations OBJECTIVE To evaluate the effects of leaving the parietal peritoneum open at lower segment cesarean section ( LSCS ) measured by postoperative pain . DESIGN A r and omized , prospect i ve and double-blind study . SETTING Department of Obstetrics and Gynecology , Aarhus University Hospital , Denmark . POPULATION Forty women referred for an elective cesarean section were assigned to one of two groups : peritoneum open ( n=21 ) or peritoneum closed ( n=19 ) . METHODS Pain was evaluated twice a day from the first to the fifth postoperative day by  Visual Analog Scales .  MAIN OUTCOME MEASURES Postoperative pain . Other outcomes include usage of analgesics , bowel function , postoperative complications , and hospital stay . RESULTS We found no overall difference in postoperative pain . A tendency to less pain was found in the non-closure group from the third postoperative day to the fifth postoperative day . No differences were found either in the incidence of postoperative complications , or the time to return of bowel function . Concerning 
    Output:
    
Non-closure of the peritoneum reduced operating time when both layers or one layer was not sutured .
There was significantly less postoperative fever and reduced postoperative stay in hospital for non-closure of the visceral peritoneum and non-closure of both layers .
There were no other statistically significant differences .
The trend for analgesia requirement and wound infection tended to favour non-closure , while endometritis results were variable .
There was improved short-term postoperative outcome if the peritoneum was not closed .
At present there is no evidence to justify the time taken and cost of peritoneal closure