Successful cesarean section utilizing a right paramedian incision in a woman who had a mitrofanoff procedure: A case report

Cesarean section (CS) is among the most common surgical operations worldwide. While transverse Pfannenstiel incisions are now considered standard of care, vertical incisions—including midline and paramedian—were historically more common. In certain patients, anatomical variations or prior surgical procedures can render Pfannenstiel incisions unsafe. Paramedian incisions, though less frequently used in obstetrics, may offer advantages such as improved lateral exposure, reduced adhesion risks, and decreased risk of future herniation. We describe the delivery of a patient with a history of a Mitrofanoff procedure, in whom dense adhesions and anatomical alterations posed challenges to standard CS approaches. A paramedian incision was selected due to its ability to provide safer exposure while avoiding the region of prior reconstructive surgery. This approach minimized the risk of inadvertent injury, optimized visualization, and facilitated successful delivery. This case highlights that adhesions and anatomical modifications from prior procedures can complicate routine obstetric surgical planning. In such patients, a paramedian incision may be superior to the Pfannenstiel approach by enhancing surgical exposure and reducing the likelihood of complications. A multidisciplinary team and adaptable delivery plan are critical to achieving favorable maternal and neonatal outcomes in complex surgical scenarios.