Objective To determine the feasibility and safety of transverse supra/sub- umbilical incisions for elective caesarean section in super-obese women.

Design Case series.

Setting Tertiary UK obstetric centre in 2013.

Population 15 women with booking BMI >45 kg/m² and deemed to be suitable for the surgery. During the year we booked 258 women with BMI 40–50 kg/m² and 34 women with BMI >50 kg/m². Obesity alone was not an indication for elective Caesarean section.

Methods A transverse supra or sub-umbilical incision was performed at the time of surgery instead of using a traditional transverse supra-pubic approach. Thirteen of the fifteen surgeries were performed by the same operator. Women were reviewed in the clinic at 6 weeks post surgery.

Results Three supra-umbilical and eleven sub-umbilical incisions were performed.

Conclusions Although numbers are small, it would appear that this approach is feasible and confers operating times, blood loss and hospital stay similar to standard elective caesarean in the normal population. No woman required a blood transfusion or had any complications after surgery and this may translate into potential recovery benefits. Further evaluation is required, ideally through a randomised controlled trial in order to test this hypothesis.