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Suture repair of umbilical hernia during caesarean section: a case-control study

Steinemann, D. ; Limani, P. ; Ochsenbein, N. ; Krähenmann, F. ; Clavien, P.-A ; Zimmermann, R. ; Hahnloser, D.

In: Hernia, 2013, vol. 17, no. 4, p. 521-526

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    Titre
    • Suture repair of umbilical hernia during caesarean section: a case-control study
    Auteur
    • Steinemann, D.. Department of Visceral and Transplantation Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    • Limani, P.. Department of Visceral and Transplantation Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    • Ochsenbein, N.. Department of Obstetrics, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    • Krähenmann, F.. Department of Obstetrics, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    • Clavien, P.-A. Department of Visceral and Transplantation Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    • Zimmermann, R.. Department of Obstetrics, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    • Hahnloser, D.. Department of Visceral and Transplantation Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    Type de document
    • Postprint
    Identifiant OAI-PMH
    • oai:doc.rero.ch:311035
    Summary
    Purpose: The objective of this study was to investigate the additional burdens in terms of pain, prolongation of surgery and morbidity which is added to elective caesarean section if umbilical hernia suture repair is performed simultaneously. Secondly, patient's satisfaction and hernia recurrence rate were assessed. Methods: Consecutive women with symptomatic umbilical hernia undergoing internal or external suture repair during elective caesarean were included in this retrospective cohort-control study. Data on post-operative pain, duration of surgery and morbidity of a combined procedure were collected. These patients were matched 1:10 to women undergoing caesarean section only. Additionally, two subgroups were assessed separately: external and internal suture hernia repair. These subgroups were compared for patient's satisfaction, cosmesis, body image and recurrence rate. Results: Fourteen patients with a mean age of 37years were analysed. Internal suture repair (n=7) prolonged caesarean section by 20min (p=0.001) and external suture repair (n=7) by 34min (p<0.0001). Suture repair did not increase morphine use (0.38±0.2 vs. 0.4±02mg/kg body weight), had no procedure-related morbidity and prolonged hospitalization by 0.5days (p=0.01). At a median follow-up of 37 (5-125) months, two recurrences in each surgical technique, internal and external suture repair, occurred (28%). Body image and cosmesis score showed a higher level of functioning in internal suture repair (p=0.02; p=0.04). Discussion: Despite a high recurrence rate, internal suture repair of a symptomatic umbilical hernia during elective caesarean section should be offered to women if requested. No additional morbidity or scar is added to caesarean section. Internal repair is faster, and cosmetic results are better, additional skin or fascia dissection is avoided, and it seems to be as effective as an external approach. Yet, women must be informed on the high recurrence rate