Objective We sought to determine the value of extraperitoneal approach compared with transperitoneal approach during repeat cesarean section(CS).Methods We reviewed the medical records of women who underwent extraperitoneal repeat CS, and women who underwent transperitoneal repeat CS.Primary outcome measures were delivery time,operative time, neonatal outcome and surgical morbidity.Results There was a lower percentage of intestinal dysfunction and intraoperative nausea or vomiting in ECS.Delivery time and operative time were significantly shorter in ECS (P<0.001).Neonatal outcome did not differ between the two groups.Estimated blood loss during operation and within 24 hours after operation were significantly fewer in ECS(P<0.001).Postoperative exhaust time and length of hospital stay were significantly shorter in ECS (P<0.001).Patients suffered significantly less pain at time points of POH6 and POD1 in ECS compared with TCS.Fewer patients suffered from abdominal and pelvic pains at postoperative 6 weeks follow-up in ECS.There were no significant differences were found in regards to wound infection or dehiscence, pelvic or extraperitoneal hematoma, postoperative fever, intestinal dysfunction, urogenital dysfunction, urinary tract infection,endometritis, and pelvic discomfort at postoperative 6 weeks follow-up.Conclusion An extraperitoneal approach for repeat cesarean section can reduce delivery time,operative time, postoperative pain and blood loss without an increase in significant complications.