title: Staples vs subcuticular sutures for skin closure at cesarean delivery: a metaanalysis of randomized controlled trials.
abstract: Recently published randomized trials examining skin closure technique on postcesarean wound complications have produced conflicting results. We performed a metaanalysis of trials comparing staples and subcuticular sutures for skin closure at cesarean section (CS). Pooled outcome measures were calculated using random effects models. Primary outcomes were rates of wound dehiscence (separation) and a composite wound complication rate. Secondary outcomes were patient satisfaction, operating time, and postoperative pain. A total of 877 women from 5 trials were included. Both wound separation (pooled odds ratio, 4.01; P < .0001) and composite wound complication (pooled odds ratio, 2.11; P = .003) rates were higher with staples. The use of staples reduced operating time (weighted mean difference, -5.05 minutes; P = .021). Data on postoperative pain and patient satisfaction were insufficient for metaanalysis. Our findings suggest a possible benefit with subcuticular sutures compared to skin staples for skin closure at CS. However, the optimal skin closure technique at CS demands further study.
authors.affiliation: Department of Obstetrics and Gynecology, Addenbrooke's Hospital, Cambridge University Hospitals, United Kingdom.
authors.forename: Felix S H
authors.initials: FS
authors.lastname: Clay
authors.forename: Colin A
authors.initials: CA
authors.lastname: Walsh
authors.forename: Stewart R
authors.initials: SR
authors.lastname: Walsh
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects / Q000295:instrumentation*; D062109:Dermatologic Surgical Procedures; D005260:Female; D006801:Humans; D010149:Postoperative Pain / Q000209:etiology; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D013530:Surgical Wound Infection / Q000209:etiology; D013537:Sutures / Q000009:adverse effects*; D016896:Treatment Outcome