Suture versus staples for skin closure after cesarean: a metaanalysis

Area of Science:

• Obstetrics and Gynecology
• Surgical Innovation
• Evidence-Based Medicine

Background:

• Cesarean delivery is a common surgical procedure.
• Skin closure methods impact wound healing and patient outcomes.
• Metal staples and absorbable sutures are common cesarean skin closure techniques.

Purpose of the Study:

• To conduct a meta-analysis comparing subcuticular absorbable sutures versus metal staples for cesarean skin closure.
• To evaluate outcomes including wound complications, pain, satisfaction, cosmesis, and operating time.

Main Methods:

• Systematic literature search of MEDLINE, Cochrane Databases, and ClinicalTrials.gov.
• Inclusion of randomized trials comparing absorbable suture and metal staple cesarean skin closure.
• Data extraction on wound complications, pain, satisfaction, cosmesis, and operative time.

Main Results:

• Twelve randomized trials (3112 women) were analyzed.
• Suture closure significantly reduced overall wound complications (RR 0.49, 95% CI 0.28-0.87), mainly due to fewer wound separations (RR 0.29, 95% CI 0.20-0.43).
• No significant differences were found in infection, hematoma, seroma, readmission, pain, satisfaction, or cosmesis. Operating time was ~7 minutes longer with sutures.

Conclusions:

• Subcuticular absorbable sutures decrease wound morbidity, specifically separation, after cesarean delivery.
• Suture closure offers comparable patient satisfaction, pain perception, and cosmetic results to staples.
• The increased operating time for sutures is a consideration, but the reduction in wound complications is a significant benefit.