Supraumbilical Transverse Incision for Cesarean Section in Severely Obese Patients: The Experience of a French Hospital from 2009 to 2014

Abstract

Aim: To describe our experience in supraumbilical cesarean deliveries in severely and morbidly obese patients (body mass index > 35 kg/m 2 ) with a voluminous abdominal panniculus. Methods: A retrospective study in France between January 2009 and May 2014. Every woman who underwent a cesarean delivery with a supraumbilical incision was included through her digital medical record. A senior doctor made the decision for a supraumbilical skin incision after careful examination of the patient's anatomical conditions. Results: Twenty patients were included, for a total of 21 cesarean deliveries. Their mean body mass index 50 (40 -61.7). Nineteen of them (95.0%) had an abdominal panniculus in supine "apron" position. Twelve patients (57.1%) had a scarred uterus. During the cesarean section, 14 (66.7%) had a segmentary hysterotomy. The median operative time was 49 minutes (32 -70). Four patients (19.1%) had a postpartum hemorrhage and 4 (19.1%) a postpartum infectious complication, none of which were severe. Conclusions: In this specific population of severely obese women undergoing cesarean procedures, variations in anatomy require each patient's incision choice to be individualized. In women with a voluminous panniculus the supraumbilical skin incision seems to offer an adequate exposure to the peritoneal cavity and the lower uterine segment, therefore allowing to safely carry out the procedure. However a prospective study on a larger sample remains necessary to compare this technique to the classical cesarean procedure.

Comparison between Pfannenstiel Incision and higher transverse Cohen incision, during elective Cesarean section, a randomized controlled trial among morbidly obese parturients

“…Stewart el al., reported less postoperative complication rate among 20 studied patients. However, their study population was small to compare the postoperative adverse result with controls (12). Saha et al, found at 12 weeks after surgery, there were no discernible changes in the look of the scar between the two groups, nor were there any variations in the postoperative wound problems.…”