• A M Madsen, M L Dow, C M Lohse, and J A Tessmer-Tuck.
• Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA.
• BJOG. 2019 Mar 1; 126 (4): 502-510.

ObjectiveTo compare outcomes of efficiency, safety, patient, and surgeon satisfaction between absorbable subcuticular staples and subcuticular suture for caesarean section skin closure.DesignA prospective, randomised, non-blinded, parallel-group trial.SettingMayo Clinic Family Birth Center in Rochester, MN, USA.PopulationAt least 18 years old and 24 weeks' gestation, undergoing caesarean section. Exclusion criteria were body mass index >50, chorioamnionitis, intrauterine fetal death, and multifetal gestation.MethodsPatients were stratified by prior caesarean section, body mass index, and surgeon level and randomised to absorbable subcuticular staples or subcuticular suture. Electronic medical records and surveys were used.Main Outcome MeasuresPrimary outcomes were total operating time, from incision start to close. Secondary outcomes included subcuticular skin closure time, patient and surgeon satisfaction, percutaneous injuries, pain (analgesic use), cosmesis, and wound complications.ResultsOf 220 randomised patients, 206 were included in the final analysis (103 per group). Baseline characteristics were similar. The primary outcome of total operative time was not significantly different between groups [54.0 (44.9-63.6) versus 58.0 (50.4-68.2) minutes, P = 0.053]. The subcuticular staple group had shorter subcuticular skin closure time [median 2.6 (1.8-4.0) versus 8.5 (6.2-10.5) minutes, P < 0.001]. There were no differences in analgesic use, wound complications, cosmesis or patient satisfaction. One needlestick injury occurred with suture. Surgeons were more likely to recommend (97% versus 85%, P = 0.004) and use (98% versus 82%, P < 0.001) absorbable subcuticular staples.ConclusionFor caesarean section skin closure, absorbable subcuticular staples did not result in significantly different total operative times compared with sutures. Analgesic use, wound complications, and cosmesis were comparable. Patient and surgeon satisfaction were high with both methods.Tweetable AbstractAbsorbable subcuticular staples associated with a similar total operative time compared with suture.© 2018 Royal College of Obstetricians and Gynaecologists.

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