title: Suture repair of umbilical hernia during caesarean section: a case-control study.
abstract: OBJECTIVE
  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 37 years were analysed. Internal suture repair (n = 7) prolonged caesarean section by 20 min (p = 0.001) and external suture repair (n = 7) by 34 min (p < 0.0001). Suture repair did not increase morphine use (0.38 ± 0.2 vs. 0.4 ± 02 mg/kg body weight), had no procedure-related morbidity and prolonged hospitalization by 0.5 days (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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Visceral and Transplantation Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. daniel.steinemann@gmx.ch
authors.forename: D C
authors.initials: DC
authors.lastname: Steinemann
authors.forename: P
authors.initials: P
authors.lastname: Limani
authors.forename: N
authors.initials: N
authors.lastname: Ochsenbein
authors.forename: F
authors.initials: F
authors.lastname: Krähenmann
authors.forename: P-A
authors.initials: PA
authors.lastname: Clavien
authors.forename: R
authors.initials: R
authors.lastname: Zimmermann
authors.forename: D
authors.initials: D
authors.lastname: Hahnloser
mesh_terms: D058107:Abdominal Wound Closure Techniques; D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001828:Body Image; D016022:Case-Control Studies; D002585:Cesarean Section / Q000009:adverse effects; D004954:Esthetics; D005260:Female; D006554:Hernia, Umbilical / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D009020:Morphine / Q000627:therapeutic use; D061646:Operative Time; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology*; D017060:Patient Satisfaction; D012008:Recurrence; D012189:Retrospective Studies; D013536:Suture Techniques
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine
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