***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 
    ***DOCUMENTATION*** 
    ***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 OBJECTIVE To determine the effect of closure or non-closure of the visceral peritoneum at cesarean delivery on uterine scar formation assessed at repeat cesarean delivery . METHODS Women undergoing initial cesarean delivery were allocated into 2 groups : group 1 underwent visceral peritoneal closure , while in group 2 the visceral peritoneum was not closed . At repeat cesarean delivery 4 specimens from the initial uterine scar were collected and assessed by light microscopy and scanning electron microscopy . RESULTS In group 1 , 57 % of women had adhesions compared with 20.6 % in group 2 ( P<0.05 ) . Light microscopy revealed reactive mesothelial hyperplasia ( 51.8 % vs 13.7 % ) , submesothelial fibrosis ( 48.1 % vs 6.8 % ) , and neoangiogenesis of mesothelial stroma ( 44.4 % vs 12 % ) in group 1 and group 2 patients , respectively ( P<0.05 ) . Scanning electron microscopy showed more patients with pericytes on the surface of microvessels in group 1 compared with group 2 ( 26.3+/-1.4 vs 11.5+/-1.1 patients ; P<0.05 ) . CONCLUSION Closure of the visceral peritoneum at cesarean delivery may produce an inflammatory reaction and adhesions , evidence d by reactive and regenerative mesothelial hyperplasia and submesothelial fibrosis BACKGROUND Variations exist in the surgical techniques used for caesarean section and many have not been rigorously assessed in r and omised controlled trials . We aim ed to assess whether any surgical techniques were associated with improved outcomes for women and babies . METHODS CORONIS was a pragmatic international 2 × 2 × 2 × 2 × 2 non-regular fractional , factorial , unmasked , r and omised controlled trial that examined five elements of the caesarean section technique in intervention pairs . CORONIS was undertaken at 19 sites in Argentina , Chile , Ghana , India , Kenya , Pakistan , and Sudan . Each site was assigned to three of the five intervention pairs : blunt versus sharp abdominal entry ; exteriorisation of the uterus for repair versus intra-abdominal repair ; single-layer versus double-layer closure of the uterus ; closure versus non-closure of the peritoneum ( pelvic and parietal ) ; and chromic catgut versus polyglactin-910 for uterine repair . Pregnant women were eligible if they were to undergo their first or second caesarean section through a planned transverse abdominal incision . Women were r and omly assigned by a secure web-based number allocation system to one intervention from each of the three assigned pairs . All investigators , surgeons , and participants were unmasked to treatment allocation . The primary outcome was the composite of death , maternal infectious morbidity , further operative procedures , or blood transfusion ( > 1 unit ) up to the 6-week follow-up visit . Women were analysed in the groups into which they were allocated . The CORONIS Trial is registered with Current Controlled Trials : IS RCT N31089967 . FINDINGS Between May 20 , 2007 , and Dec 31 , 2010 , 15 935 women were recruited . There were no statistically significant differences within any of the intervention pairs for the primary outcome : blunt versus sharp entry risk ratio 1·03 ( 95 % CI 0·91 - 1·17 ) , exterior versus intra-abdominal repair 0·96 ( 0·84 - 1·08 ) , single-layer versus double-layer closure 0·96 ( 0·85 - 1·08 ) , closure versus non-closure 1·06 ( 0·94 - 1·20 ) , and chromic catgut versus polyglactin-910 0·90 ( 0·78 - 1·04 ) . 144 serious adverse events were reported , of which 26 were possibly related to the intervention . Most of the reported serious adverse events were known complications of surgery or complications of the reasons for the caesarean section . INTERPRETATION These findings suggest that any of these surgical techniques is acceptable . However , longer-term follow-up is needed to assess whether the absence of evidence of short-term effects will translate into an absence of long-term effects . FUNDING UK Medical Research Council and WHO Introduction and hypothesisWe hypothesized that upward bladder traction by visceral peritoneal closure during cesarean sections may have an impact on postpartum urinary complaints . Methods Based on a 90 % power of the study and a 95 % confidence interval , a sample size of 114 patients in each arm was needed to detect a 15 % difference between both groups regarding postpartum urinary incontinence . To account for follow-up losses , we prospect ively r and omized 620 term primigravidas undergoing non-emergency cesareans  into two groups ( 310 each ) : group 1 , visceral peritoneal closure ; group 2 , non-closure . We compared perineal ultrasound findings 30 min before and 48 h after surgery . The UDI-6 question naire was used to assess urinary complaints . Results Group 1 showed significant widening of the posterior urethrovesical angle and alpha angle , more urethral descent 48 h postpartum and higher incidence of frequency , urge and stress incontinence 8 weeks postpartum . Symptoms disappeared almost completely after 6 months . Conclusions Compared to visceral peritoneal non-closure , cesarean with visceral closure is associated with significant postpartum frequency of urination and /or incontinence that disappear without treatment almost completely within 6 months Summary A prospect i ve r and omised study of 54 patients undergoing caesarean section was carried out to determine if non-closure of peritoneum at  lower segment caesarean section  has advantages over suture peritonisation with regard to postoperative morbidity . A total of 27 women were r and omised to closure and 27 to non-closure of peritoneum .  Management decisions were made without reference to treatment groups . Statistical analysis compared the outcome between the two groups . The results revealed that anaesthesia and operating times were significantly shorter in patients that had the peritoneum left open . The incidence of febrile morbidity , wound infection , duration of postoperative and duration of hospital stay were not significantly different in both groups ( p < 0.05 ) . The study concludes that non-closure of peritoneum is associated with significantly reduced operation and anaesthesia time with a non-significant difference in immediate postoperative outcome .  Non-closure of peritoneum should be adopted at caesarean delivery 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 Joel-Cohen incision followed by nonclosure of pelvic and parietal peritoneum has been advocated as an alternative method to the Pfannenstiel incision with peritonealization at cesarean section . A r and omized trial was design ed to compare intra- and postoperative morbidity between the two techniques . Women to undergo a cesarean section were r and omly allocated to have either the Joel-Cohen incision with the parietal and pelvic peritoneum left open ( group 1 ) or to have the Pfannenstiel incision with both peritoneal layers sutured ( group 2 ) . The myometrium was closed with 1 - 0 polyglactin 910 suture using a continuous single-layer nonlocking technique .  Patients in group 2 had the peritoneum approximated with 2 - 0 polyglactin 910 suture . The fascia was sutured with continuous 1 - 0 polyglactin 910 suture in all cases . Opening time was defined as the interval from skin incision to the opening of the uterine cavity . Febrile morbidity was defined as a temperature > or = 38 degrees C on two occasions 4 hours ( hr ) apart excluding the first postoperative day . Endometritis was defined as postpartum temperature > or = 38 degrees C on two occasions 4 hr apart , with uterine tenderness and /or foul-smelling lochia .  One hundred forty-nine and 150 patients were allocated to group 1 and to group 2 
    Output:
    
There was no significant reduction in postoperative pyrexia .
Non-closure versus closure of visceral peritoneum when parietal peritoneum is closed There was reduction in all the major urinary symptoms of frequency , urgency and stress incontinence when the visceral peritoneum is left unsutured .
Authors ’ conclusions There was a reduction in operative time across all the subgroups .
There was also a reduction in the period of hospitalisation postcaesarean section except in the subgroup where parietal peritoneum only was not sutured where there was no difference in the period of hospitalisation .
There is currently insufficient evidence of benefit to justify the additional time and use of suture material necessary for peritoneal closure .
Plain Language Summary Closure versus non-closure of the peritoneum at caesarean section : long- and short-term outcome Not stitching the peritoneum after caesarean section takes less theatre time and therefore has less cost , but information on possible long-term disadvantages are limited .
Longer-term outcomes were not adequately assessed , particularly adhesion formation , subfertility and ease of other surgeries in later life .