Cesarean section (CS) incision wounds closed with sutures show a lower rate of complications compared with wounds closed with staples, according to a new study.
Researchers at the Geisinger Health System (Danville, PA, USA), Yale-New Haven Hospital (New Haven, CT, US), and other institutions conducted a prospective, randomized clinical trial involving 746 women undergoing CS delivery at 23 weeks of gestation or greater. The women were randomized to closure of the low-transverse skin incision with suture (376 patients) or staples (370 patients), after stratifying by body mass index (BMI) and primary compared with repeat CS delivery. The primary outcome was incidence of wound complications.
The results showed that 58 women (7.8%) had wound complications, which were predefined as a composite of infection, hematoma, seroma, separation of one cm or longer, or readmission for wound complications. Of these, 4.9% were in the suture group and 10.6% in the staple group. The difference was largely the result of the incidence of wound separation in the respective groups (1.6% in the suture group compared with 7.4% in the staple group). The study was published in the June 2014 issue of Obstetrics and Gynecology.
“There has been ongoing debate in the field about the use of sutures versus staples. C-sections are a common procedure in the United States, and yet we still haven't established the best way to close these incisions,” said senior author Vincenzo Berghella, MD, director of the Society for Maternal-Fetal Medicine (Washington DC, USA). “Based on these results, we recommend that C-section incisions be closed with stitches rather than staples.”
In the United States, 33% of all deliveries are performed by CS; in China, the rate is as high as 46%. A CS delivery is most commonly performed through a suprapubic low-transverse skin incision. At the end of the operation, the skin incision is typically closed with the placement of either a continuous subcutaneous suture that dissolves over time or multiple metal staples that are removed at a later date. While recent studies demonstrate suture superiority, most surgeons still use staples due to lower cost and faster procedure time.
Geisinger Health System
Yale-New Haven Hospital
Society for Maternal-Fetal Medicine