Background&#xa0;and objective <p>The high prevalence of Morbidly obese Egyptian patients presents surgical problems for cesarean sections (CS), including a higher risk of wound infections. This study examines the impact of a transverse supraumbilical (TSU) incision in these patients. </p> Patients and methods <p>We conducted a randomized controlled trial on 72 morbidly obese patients (BMI &gt;40 kg/m²) scheduled for cesarean section at Ain Shams University Hospital from March 2016 to August 2018. Participants were divided into Group A (36 patients) with a transverse supraumbilical (TSU) incision and Group B (36 patients) with a conventional Pfannenstiel incision. The primary outcome measured was the incidence of wound infection, while secondary outcomes included operative time, postoperative pain, hospital stay, blood loss, postoperative mobility, and intestinal motility.</p> Results <p>The results indicated no significant differences between the groups regarding age, BMI, parity, diabetes mellitus, and history of previous cesarean sections. The incidence of surgical site infection was significantly lower in the transverse supraumbilical group (11.1%, 4/36) compared to the Pfannenstiel group (58.3%, 21/36), with an absolute risk reduction of 47.2% (95% CI: 27.8% to 66.6%). Other parameters like operative time, hematocrit drop, pain score, hospital stay, and intestinal motility showed no significant differences between the groups (<i>P</i>&gt;0.05). </p> Conclusion <p>Supraumbilical transverse incisions are a safe, effective alternative to Pfannenstiel incisions in morbidly obese women, with better wound infection rates and easier access. Further research is needed to confirm the benefits and to assess patient satisfaction.</p> Trial registration <p>This study was registered prospectively in clinicaltrials.gov (NCT02692729) on 1.3.2016.</p>