Cesarean section and simultaneous hernia repair.

HYPOTHESIS The combination of cesarean section with inguinal or umbilical hernia repair is safe, effective, and well-accepted compared with cesarean section alone. DESIGN Retrospective comparative study. SETTING Tertiary care university hospital. PATIENTS Eight patients undergoing cesarean section combined with hernia repair (inguinal in 5 and umbilical in 3) vs 305 low-risk patients undergoing cesarean section alone. MAIN OUTCOME MEASURES Operation time, blood loss, opiate use, peripartum complications, hospital stay, hernia recurrence, and patient impression. RESULTS The combined procedure took significantly longer than cesarean section alone in the case of inguinal but not umbilical hernia. There were no major complications. Wound healing was delayed, without infection, in 1 patient with an inguinal hernia. Blood loss, opiate use, and hospital stay did not differ significantly from those of controls. No hernia recurred after a mean observation period of 56 months. Seven of the 8 patients reported that they would recommend the combined operation. CONCLUSIONS Combined cesarean section and hernia repair avoids rehospitalization for separate hernia repair. With a single incision (in the case of inguinal hernia repair), single anesthesia, and single hospital stay, the combined procedure confers valuable advantages for both patient and hospital in time, cost, and convenience, not to mention avoiding the separation of mother from newborn entailed by reoperation. Our results in a pilot group indicate that the combination approach is safe, effective, and well accepted. Confirmation in a larger population should establish it as a recommendable procedure.

[1]  M. Ather,et al.  Is there a difference in early perioperative morbidity in transurethral resection of prostate (TURP) versus TURP with cystolitholapaxy and TURP with inguinal herniorrhaphy? , 2004, International Urology and Nephrology.

[2]  A. Arroyo,et al.  Randomized clinical trial comparing suture and mesh repair of umbilical hernia in adults , 2001, The British journal of surgery.

[3]  A. Buffler,et al.  Long-term recurrence after laparoscopic surgery of inguinal hernias , 2001, Hernia.

[4]  R. Huch,et al.  No benefit from post-caesarean wound drainage. , 2001, Swiss medical weekly.

[5]  R. Huch,et al.  No benefit from post-caesarian wound drainage: a prospective randomized controlled trial , 2001, Swiss Medical Weekly.

[6]  L. Sarli,et al.  Hernioplasty and simultaneous laparoscopic cholecystectomy: a prospective randomized study of open tension-free versus laparoscopic inguinal hernia repair. , 2001, Surgery.

[7]  A. Voitk,et al.  Laparoscopic Repair of Inguinal Hernias with Higher Risk for Recurrence: Independent Assessment of Results from 121 Repairs , 2001, The American surgeon.

[8]  Jaganathan,et al.  Combined transurethral prostatectomy and inguinal hernia repair: a retrospective audit and literature review , 1999, BJU international.

[9]  J. Müller,et al.  Prospective randomized study comparing laparoscopic and open tension-free inguinal hernia repair with Shouldice's operation. , 1998, American journal of surgery.

[10]  J. Catheline,et al.  Hernies de l'aine. Résultats à 4 ans de deux études prospectives randomisées comparant les opérations de Shouldice et de Stoppa à l'abord laparoscopique totalement pré-péritonéal (461 patients) , 1998 .

[11]  N. Rizk,et al.  [Inguinal hernia. 4-year follow-up of 2 comparative prospective randomized studies of Shouldice and Stoppa operations with pre-peritoneal totally laparoscopic approach (461 patients)]. , 1998, Annales de chirurgie.

[12]  G. Beets,et al.  Longterm followup (12-15 years) of a randomized controlled trial comparing Bassini-Stetten, Shouldice, and high ligation with narrowing of the internal ring for primary inguinal hernia repair. , 1997, Journal of the American College of Surgeons.

[13]  R. Bendavid.  Die Herniotomie nach Shouldice The Shouldice repair , 1997, Der Chirurg.

[14]  D. Bani,et al.  Relaxin: a pleiotropic hormone. , 1997, General pharmacology.

[15]  A. Fingerhut,et al.  Shouldice Inguinal Hernia Repair in the Male Adult: The Gold Standard? A Multicenter Controlled Trial in 1578 Patients , 1995, Annals of surgery.

[16]  R. Ikard.  Combining laparoscopic cholecystectomy and (peri) umbilical herniorrhaphy. , 1995, The American surgeon.

[17]  W. Watson,et al.  The effect of nonobstetric operation during pregnancy. , 1993, Surgery, gynecology & obstetrics.

[18]  R. Lanzafame.  Techniques for the simultaneous management of incarcerated ventral herniae and cholelithiasis via laparoscopy. , 1993, Journal of laparoendoscopic surgery.

[19]  N. Galai,et al.  Differential effect of risk factors on early and late wound infections in patients undergoing herniorrhaphies. , 1992, Annals of epidemiology.

[20]  A. González-Ojeda,et al.  Combined inguinal herniorrhaphy and transurethral prostatectomy , 1991, The British journal of surgery.

[21]  C. Johnson,et al.  A prospective study of bilateral inguinal hernia repair. , 1990, Annals of the Royal College of Surgeons of England.

[22]  A. Altchek,et al.  Preperitoneal herniorrhaphy: adjunct to cesarean section. , 1987, Obstetrics and gynecology.

[23]  E. Kursh,et al.  Preperitoneal herniorrhaphy. Adjunct to prostatic surgery. , 1975, Urology.