title: Suture versus staples for skin closure after cesarean: a metaanalysis.
abstract: OBJECTIVE
  We sought to perform a metaanalysis to synthesize randomized clinical trials of cesarean skin closure by subcuticular absorbable suture vs metal staples for the outcomes of wound complications, pain perception, patient satisfaction, cosmesis, and operating time.
  
  
  METHODS
  A systematic search was performed using MEDLINE, Cochrane Databases, and ClinicalTrials.gov registries. We included randomized trials comparing absorbable suture vs metal staples for cesarean skin closure. Data were abstracted regarding wound complications, patient pain perception, patient satisfaction, cosmesis as assessed by the physician and patient, and operating time.
  
  
  RESULTS
  Twelve randomized trials with data for the primary outcome on 3112 women were identified. Women whose incisions were closed with suture were significantly less likely to have wound complications than those closed with staples (risk ratio, 0.49; 95% confidence interval [CI], 0.28-0.87). This difference remained significant even when wound complications were stratified by obesity. The decrease in wound complications was largely due to the lower incidence of wound separations in those closed with suture (risk ratio, 0.29; 95% CI, 0.20-0.43), as there were no significant differences in infection, hematoma, seroma, or readmission. There were also no significant differences in pain perception, patient satisfaction, and cosmetic assessments between the groups. Operating time was approximately 7 minutes longer in those closed with suture (95% CI, 3.10-11.31).
  
  
  CONCLUSIONS
  For patients undergoing cesarean, closure of the transverse skin incision with suture significantly decreases wound morbidity, specifically wound separation, without significant differences in pain, patient satisfaction, or cosmesis. Suture placement does take 7 minutes longer than staples.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Geisinger Medical Center, Danville, PA. Electronic address: admackeen@geisinger.edu.
authors.forename: Awathif Dhanya
authors.initials: AD
authors.lastname: Mackeen
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Geisinger Medical Center, Danville, PA.
authors.forename: Meike
authors.initials: M
authors.lastname: Schuster
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Berghella
mesh_terms: D058107:Abdominal Wound Closure Techniques; D002585:Cesarean Section / Q000379:methods*; D005260:Female; D006406:Hematoma / Q000453:epidemiology*; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D049291:Seroma / Q000453:epidemiology*; D017792:Surgical Stapling; D013530:Surgical Wound Infection / Q000453:epidemiology*; D013536:Suture Techniques
keywords: cesarean; incision closure; staples; suture; wound complications