Sutures versus clips for skin closure following caesarean section: a systematic review, meta-analysis and trial sequential analysis of randomised controlled trials.
Zaman, Shafquat Mohamedahmed, Ali Yasen Y Peterknecht, Elizabeth Zakaria, Reza Md Mohamedahmed, Saeed Y Y Hajibandeh, Shahab Hajibandeh, Shahin
Zaman, Shafquat
Mohamedahmed, Ali Yasen Y
Peterknecht, Elizabeth
Zakaria, Reza Md
Mohamedahmed, Saeed Y Y
Hajibandeh, Shahab
Hajibandeh, Shahin
Abstract
Purpose: To evaluate comparative outcomes of skin closure with clips and sutures after caesarean section (CS).
Methods: We conducted a systematic search of electronic information sources and bibliographic reference lists. Wound infection, wound separation, haematoma, seroma, re-admission, closure time, length of hospital stay, patient scar assessment scale (PSAS) and the observer scar assessment scale (OSAS) were the evaluated outcome parameters.
Results: We identified 16 randomised controlled trials reporting a total of 4926 patients who had skin closure with sutures (n = 2724) or clips (n = 2202) following CS. Use of clips was associated with a significantly higher rate of wound separation (risk ratio (RR): 2.33, P = 0.004) and longer length of hospital stay (mean difference (MD): 1.21, P = 0.03) but shorter closure time (MD: 5.35, P = 0.00001) when compared to sutures group. There was no significant difference between the two groups in the risk of wound infection (RR: 1.12, P = 0.75), haematoma formation (RR: 2.46, P = 0.23), seroma (RR: 1.17, P = 0.73), re-admission rate (RR: 1.28, P = 0.73), PSAS (MD: 0.44, P = 0.73) and OSAS (MD: 0.32, P = 0.55). Trial sequential analysis showed the meta-analysis was conclusive for wound infection, wound separation and closure time; however, it was inconclusive for length of hospital stay, PSAS and OSAS due to risk of type 2 error.
Conclusion: This meta-analysis of best available evidence (level 1) demonstrated that although skin closure with subcuticular sutures is more time-consuming than clips, it is associated with a significantly lower risk of wound separation and shorter length of hospital stay.
MIDER Authors
Affiliations
Sandwell and West Birmingham NHS Trust; Glangwili General Hospital; Atbara Teaching Hospital; Glan Clwyd Hospital; Wye Valley NHS Trust
Citations
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Date
2021-07-07
Type
Article
Subject
Collections
Citation
Zaman S, Mohamedahmed AYY, Peterknecht E, Zakaria RM, Mohamedahmed SYY, Hajibandeh S, Hajibandeh S. Sutures versus clips for skin closure following caesarean section: a systematic review, meta-analysis and trial sequential analysis of randomised controlled trials. Langenbecks Arch Surg. 2022 Feb;407(1):37-50. doi: 10.1007/s00423-021-02239-0.