Subcuticular sutures versus staples for skin closure after cesarean delivery: a meta-analysis

J Matern Fetal Neonatal Med. 2016 Nov;29(22):3705-11. doi: 10.3109/14767058.2016.1141886. Epub 2016 Feb 26.


Objective: To compare the clinical efficacy between subcuticular sutures and staples for skin closure after cesarean delivery.

Methods: PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science were searched. Only RCTs comparing subcuticular sutures to staples following cesarean delivery were included. The primary outcome was the incidence of wound complications, consisting of wound infection, wound separation, hematoma and seroma. Risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI) was calculated.

Results: Ten RCTs were included in this analysis. Subcuticular sutures were associated with significantly decreased incidence of wound complications compared to staples (RR 1.88, 95% CI 1.45-2.45). The operation time was significantly shortened when closure with staples was performed (MD -8.66 min, 95% CI -10.90 to -6.42). The two groups were comparable regarding cosmetic outcome at 6-8 weeks postoperatively, whereas subcuticular sutures were associated with a better cosmesis at 6-12 months postoperatively. There were no significant differences between groups in terms of hospital stay, postoperative pain and patient satisfaction.

Conclusions: Compared with staples following cesarean delivery, subcuticular sutures are associated with decreased risk of wound complications and better long-term cosmetic outcome, but slightly prolong duration of surgery.

Keywords: Cesarean; meta-analysis; skin closure; staple; suture.

Publication types

  • Comparative Study
  • Meta-Analysis

MeSH terms

  • Cesarean Section / methods*
  • Female
  • Humans
  • Incidence
  • Models, Statistical
  • Odds Ratio
  • Outcome Assessment, Health Care
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control
  • Pregnancy
  • Surgical Stapling
  • Suture Techniques*