Grand Rounds

Suture or Staple for Cesarean Section Skin Closure?

BACKGROUND AND PURPOSE:

Mackeen et al. (AJOG, 2017) sought to determine whether absorbable sutures or metal staples are superior for transverse cesarean section incision closure

Systematic review and meta-analysis comparing sutures to metal staples
Compared wound complications, patient pain perception, patient satisfaction, cosmesis as assessed by the physician and patient, and operating time

3112 patients were included
Patients with sutures were 71% significantly less likely to suffer wound complications
- 2.52% vs 9.40%; relative risk (RR) 0.29; 95% CI 0.20–0.43; P < .01
The lower number of wound complications was due to fewer wound separations
Operating time was 7.20 minutes longer using sutures (95% CI, 3.10–11.31; P < .01)
Other outcomes were not significantly different between the two groups, including hematoma, seroma and readmission
Obese patients
- 49% less likely to have wound complications with sutures (6.69% vs 12.84%; RR 0.51; 95% CI 0.34–0.75)
Nonobese patients
- 62% less likely to have wound complications with sutures (4.27% vs 11.24%; RR, 0.38; 95% CI 0.23–0.64)

Cesarean section closure using suture leads to slightly longer OR time but fewer wound complications due to wound separation in both obese and nonobese patients

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