, Volume 17, Issue 4, pp 521–526 | Cite as

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

  • D. C. Steinemann
  • P. Limani
  • N. Ochsenbein
  • F. Krähenmann
  • P.-A. Clavien
  • R. Zimmermann
  • D. Hahnloser
Original Article



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.


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.


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).


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.


Umbilical hernia Caesarean section Suture repair 


Conflict of interest



  1. 1.
    Dabbas N, Adams K, Pearson K, Royle G (2011) Frequency of abdominal wall hernias: is classical teaching out of date? JRSM Short Rep 2(1):5PubMedCrossRefGoogle Scholar
  2. 2.
    Buch KE, Tabrizian P, Divino CM (2008) Management of hernias in pregnancy. J Am Coll Surg 207(4):539–542PubMedCrossRefGoogle Scholar
  3. 3.
    Boissonnault JS, Blaschak MJ (1988) Incidence of diastasis recti abdominis during the childbearing year. Phys Ther 68(7):1082–1086PubMedGoogle Scholar
  4. 4.
    Oh CS, Won HS, Kwon CH, Chung IH (2008) Morphologic variations of the umbilical ring, umbilical ligaments and ligamentum teres hepatis. Yonsei Med J 49(6):1004–1007PubMedCrossRefGoogle Scholar
  5. 5.
    Beischer NA, Wein P (1996) Linea alba pigmentation and umbilical deviation in nulliparous pregnancy: the ligamentum teres sign. Obstet Gynecol 87(2):254–256PubMedCrossRefGoogle Scholar
  6. 6.
    Perry Z, Netz U, Yitzhak A, Mizrahi S (2011) Pros and cons in the approach to an incarcerated umbilical hernia in the pregnant woman. Am Surg 77(3):E43–E44PubMedGoogle Scholar
  7. 7.
    Ghnnam WM, Helal AS, Fawzy M, Ragab A, Shalaby H, Elrefaay E (2009) Paraumbilical hernia repair during cesarean delivery. Ann Saudi Med 29(2):115–118PubMedCrossRefGoogle Scholar
  8. 8.
    Gabriele R, Conte M, Izzo L, Basso L (2010) Cesarean section and hernia repair: simultaneous approach. J Obstet Gynaecol Res 36(5):944–949PubMedCrossRefGoogle Scholar
  9. 9.
    Ochsenbein-Kolble N, Demartines N, Ochsenbein-Imhof N, Zimmermann R (2004) Cesarean section and simultaneous hernia repair. Arch Surg 139(8):893–895PubMedCrossRefGoogle Scholar
  10. 10.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg 240(2):205–213PubMedCrossRefGoogle Scholar
  11. 11.
    Dunker MS, Stiggelbout AM, van Hogezand RA, Ringers J, Griffioen G, Bemelman WA (1998) Cosmesis and body image after laparoscopic-assisted and open ileocolic resection for Crohn’s disease. Surg Endosc 12(11):1334–1340PubMedCrossRefGoogle Scholar
  12. 12.
    Nolan A, Lawrence C (2009) A pilot study of a nursing intervention protocol to minimize maternal-infant separation after Cesarean birth. J Obstet Gynecol Neonatal Nurs 38(4):430–442PubMedCrossRefGoogle Scholar
  13. 13.
    Bisgaard T, Kehlet H, Bay-Nielsen M, Iversen MG, Rosenberg J, Jorgensen LN (2011) A nationwide study on readmission, morbidity, and mortality after umbilical and epigastric hernia repair. Hernia 15(5):541–546PubMedCrossRefGoogle Scholar
  14. 14.
    Arroyo A, Garcia P, Perez F, Andreu J, Candela F, Calpena R (2001) Randomized clinical trial comparing suture and mesh repair of umbilical hernia in adults. Br J Surg 88(10):1321–1323PubMedCrossRefGoogle Scholar
  15. 15.
    Stabilini C, Stella M, Frascio M, De Salvo L, Fornaro R, Larghero G, Mandolfino F, Lazzara F, Gianetta E (2009) Mesh versus direct suture for the repair of umbilical and epigastric hernias. Ten-year experience. Ann Ital Chir 80(3):183–187PubMedGoogle Scholar
  16. 16.
    Aslani N, Brown CJ (2010) Does mesh offer an advantage over tissue in the open repair of umbilical hernias? A systematic review and meta-analysis. Hernia 14(5):455–462PubMedCrossRefGoogle Scholar
  17. 17.
    Halm JA, Heisterkamp J, Veen HF, Weidema WF (2005) Long-term follow-up after umbilical hernia repair: are there risk factors for recurrence after simple and mesh repair? Hernia 9(4):334–337PubMedCrossRefGoogle Scholar
  18. 18.
    Israelsson LA, Smedberg S, Montgomery A, Nordin P, Spangen L (2006) Incisional hernia repair in Sweden 2002. Hernia 10(3):258–261PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  • D. C. Steinemann
    • 1
    • 3
  • P. Limani
    • 1
  • N. Ochsenbein
    • 2
  • F. Krähenmann
    • 2
  • P.-A. Clavien
    • 1
  • R. Zimmermann
    • 2
  • D. Hahnloser
    • 1
    • 4
  1. 1.Department of Visceral and Transplantation SurgeryUniversity Hospital ZurichZurichSwitzerland
  2. 2.Department of ObstetricsUniversity Hospital ZurichZurichSwitzerland
  3. 3.Department of SurgeryCantonal Hospital BasellandBruderholzSwitzerland
  4. 4.Department of Visceral SurgeryCentre Hospitalier Universitaire VaudoisLausanneSwitzerland

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