Abstract
ObjectiveTo estimate the incidence of incisional hernias requiring surgical repair after cesarean delivery over a 10-year period.MethodsThis population- and register-based cohort study identified all women in Denmark with no history of previous abdominal surgery who had a cesarean delivery between 1991 and 2000. The cohort was followed from their first until 10 years after their last cesarean delivery within the inclusion period or until the first of the following events: hernia repair, death, emigration, abdominal surgery, or cesarean delivery after the inclusion period. For women who had a hernia repair, hospital records regarding the surgery and previous cesarean deliveries were tracked and manually analyzed to validate the relationship between hernia repair and cesarean delivery. Data were analyzed with a competing risk analysis that included each cesarean delivery.ResultsWe identified 57,564 women who had had 68,271 cesarean deliveries during the inclusion period. During follow-up, 134 of these women had a hernia requiring repair. Of these 68 (51% [95% CI 42–60%]) were in a midline incision although the transverse incision was the primary approach at cesarean delivery during the inclusion period. The cumulated incidence of a hernia repair within 10 years after a cesarean delivery was 0.197% (95% CI 0.164–0.234%). The risk of a hernia repair was higher during the first 3 years after a cesarean delivery, with an incidence after 3 years of 0.157% (95% CI 0.127–0.187%).ConclusionsThe overall risk of an incisional hernia requiring surgical repair within 10 years after a cesarean delivery was 2 per 1000 deliveries in a population in which the transverse incision was the primary approach at cesarean delivery.
Highlights
Cesarean delivery is the most common surgical procedure in the United States, and the rates are increasing worldwide [1,2]
158 were identified as having a subsequent hernia repair performed within 10 years after their cesarean delivery within the inclusion period
4 women had a history of previous abdominal surgery, 4 had abdominal surgery after the cesarean delivery but before the hernia repair, one had the hernia repair done coincidently with the including cesarean delivery, 9 hernias were not in the cesarean incision, 5 had diastasis recti without hernia, and 1 had no hernia
Summary
Cesarean delivery is the most common surgical procedure in the United States, and the rates are increasing worldwide [1,2]. In the United States, Latin America, Australia, and several European countries cesarean delivery rates are presently above 30% [3,4,5,6]. Several studies have found both short- and long-term complications related to cesarean delivery [7,8,9,10,11]. Incisional hernia is a well-known long-term complication of abdominal surgery, with a reported incidence of 3.0–20.6% in association with midline incisions and 0–2.1% with lower transverse incisions [12,13,14,15,16,17,18,19]. Studies have found that more than 50% of incisional hernias occur more than 1 year after surgery, indicating that the incidence of incisional hernia after cesarean delivery might be underreported [16,22]
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