***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 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 , respectively . A shorter median ( range ) opening time [ 4 min ( 2 - 21 ) vs. 6 min ( 2 - 19 ) , respectively , p < 0.01 ] and a shorter median ( range ) operative time [ 30 min ( 10 - 65 ) vs. 40 min ( 20 - 110 ) , respectively , p < 0.01 ] were observed in group 1 . No difference was found in terms of intraoperative complications , proportion of patients who required transfusion , endometritis , sepsis , febrile morbidity , and urinary tract infections . A higher rate of wound infections was found in group 2 than in group 1 [ 14 of 150 ( 9.3 % ) vs. 2 of 149 ( 1.3 % ) , respectively , p < 0.01 ] . The Joel-Cohen incision without peritonealization result ed in a shorter opening and total operative time than the Pfannenstiel laparotomy with peritonealization . This was accomplished with a reduction of wound infections OBJECTIVE To compare the intensity of postcesarean pain between closure and nonclosure of peritoneum in the women with a midline incision and one previous cesarean section . STUDY DESIGN The setting was an obstetrics unit of a university teaching hospital . A double-blind r and omized trial was performed on 60 pregnant women with a midline incision and one previous cesarean section who underwent elective repeated cesarean section . Thirty women each were allocated to the " closure " group and the " nonclosure " group . The principal outcome measure was the postcesarean pain assessed by visual analog scale ( VAS ) . RESULTS There was no difference in postoperative pain for closure and nonclosure of peritoneum groups in repeated cesarean patients ; while resting ( P=0.8 ) , while moving in bed ( P=0.94 ) , and while walking ( P=0.52 ) . The use of opiate ( P=0.27 ) and oral analgesics ( P=0.37 ) also suggested no difference . No differences were found in duration of the operation , incidence of postoperative complications , time of returned bowel function , and length of the hospital stay . CONCLUSION The VAS showed no difference in postcesarean pain between closure and nonclosure of peritoneum 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 OBJECTIVE To compare long-term morbidity of nonclosure and closure of the peritoneum  at caesarean section . STUDY DESIGN Participants to a r and omised controlled trial were contacted 7 years later . Outcome measures were assessed by a postal question naire and reports of subsequent operations . RESULTS We were able to contact 226 of the 280 women recruited initially , and 144 responded to the question naire . Sixty-nine had been allocated to nonclosure of the peritoneum and 75 to closure . Baseline characteristics at r and omisation were comparable both between the respondents and the non-respondents , and between originally allocated groups . No statistically significant difference was found between the two groups regarding fertility , abdominal pain , and urinary symptoms . Among 29 reports of subsequent abdominal surgery , 14 mentioned the presence of adhesions ( 8 in the nonclosure and 6 in the closure group ; P=0.47 ) . The number of women reporting at least one significant morbidity was similar between groups ( 24 in the nonclosure and 19 in the closure group ; P=0.72 ) . CONCLUSION Nonclosure and closure of the peritoneum at caesarean section result in similar long-term morbidity 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 
    Output:
    
There was significantly less postoperative fever and reduced postoperative stay in hospital for visceral peritoneum and for both layer non-closure .
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 .
REVIEW ER 'S CONCLUSIONS There was improved short-term postoperative outcome if the peritoneum was not closed .
There is at present no evidence to justify the time taken and cost of peritoneal closure