We read with interest the article by Walsh and Walsh, who performed a metaanalysis on 3183 women who underwent cesarean section and compared extraabdominal with intraabdominal uterine repair at cesarean. The authors reported that there is no significant difference between the 2 methods of repair for all outcomes evaluated (nausea and vomiting, intraoperative pain, blood transfusion, venous thromboembolism, febrile morbidity, endometritis, wound infection, and death). They concluded that the method of repair should be chosen according to the surgeon preference. However, all studies cited in their article involved women under either spinal or general anesthesia. Those types of anesthesia make an excellent motor block and may cause few secondary effects, such as nausea, during uterine exteriorization. We want to bring forward the case of women in labor under epidural anesthesia who need an emergency cesarean section. Since epidural anesthesia causes less effective sensitive and motor block compared with spinal and general anesthesia, uterine manipulation causing vagal stimulation during surgery may increase patients’ discomfort. To our knowledge, no study on extraabdominal vs intraabdominal uterine repair at cesarean was conducted with women under epidural anesthesia. Therefore, we would like to amend the conclusion of the metaanalysis: the method of uterine repair, in situ or with uterine exteriorization, should be chosen according to the surgeon preference only for women under general and spinal anesthesia but not for conversion of epidural labor analgesia to epidural anesthesia for intrapartum cesarean delivery. In this specific case, secondary effects may be more frequent when uterine exteriorization is performed.