The impact of subcutaneous tissue suturing at caesarean section on wound complications: a meta-analysis.
BACKGROUND
Caesarean wound complications are frequently observed in everyday practice.


OBJECTIVE
To study whether subcutaneous tissue closure following caesarean section results in decreased wound complications.


METHODS
We systematically searched Medline (1966-2016), Scopus (2004-2016), ClinicalTrials.gov (2008-2016) and Cochrane Central Register of Controlled Trials CENTRAL (1999-2016) databases together with reference lists from included studies.


METHODS
Randomised and quasi-randomised trials that investigated the impact of subcutaneous tissue suturing on wound complications following caesarean section were held eligible for inclusion. Retrospective studies and prospective nonrandomised studies were excluded from the present meta-analysis.


METHODS
The methodological quality of studies was assessed with the Jadad scale. Statistical meta-analysis was performed with the RevMan 5.3 software.


RESULTS
Ten studies were finally included in our meta-analysis, which involved 3696 women delivered by caesarean section. Re-approximation of the subcutaneous tissue significantly reduced the odds of developing any type of wound complication [3811 women, random effects model (REM), odds ratio (OR) 0.66, 95% CI 0.47-0.93]. The incidence of seroma was also decreased (1979 women, REM, OR 0.53, 95% CI 0.33-0.84). On the other hand, the incidence of haematoma remained unaffected by subcutaneous closure (1663 women, REM, OR 0.74, 95% CI 0.22-2.42) as well as the likelihood of developing a wound infection (1971 women, REM, OR 0.99, 95% CI 0.70-1.41).


CONCLUSIONS
The results of our meta-analysis suggest that subcutaneous tissue closure may benefit women undergoing caesarean section. Current data in women with high body mass index remain very limited; hence, definitive conclusions are precluded for this specific group.


CONCLUSIONS
Subcutaneous tissue closure may benefit women undergoing caesarean section.
Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, Athens, Greece.
V
V
Pergialiotis
Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, Athens, Greece.
A
A
Prodromidou
Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, Athens, Greece.
D N
DN
Perrea
Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, Athens, Greece.|Department of Obstetrics and Gynaecology, Epsom & St Helier University Hospitals NHS Trust, London, UK.|St George's University of London, London, UK.
S K
SK
Doumouchtsis
D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D040521:Subcutaneous Tissue / Q000601:surgery*; D013537:Sutures / Q000009:adverse effects*
Caesarean; complications; haematoma; seroma; subcutaneous; wound