PMID- 34232372
OWN - NLM
STAT- MEDLINE
DCOM- 20220217
LR  - 20220217
IS  - 1435-2451 (Electronic)
IS  - 1435-2443 (Linking)
VI  - 407
IP  - 1
DP  - 2022 Feb
TI  - Sutures versus clips for skin closure following caesarean section: a systematic 
      review, meta-analysis and trial sequential analysis of randomised controlled 
      trials.
PG  - 37-50
LID - 10.1007/s00423-021-02239-0 [doi]
AB  - 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.
CI  - (c) 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, 
      part of Springer Nature.
FAU - Zaman, Shafquat
AU  - Zaman S
AD  - Department of General Surgery, Sandwell and West, Birmingham Hospitals NHS Trust, 
      Birmingham, UK.
FAU - Mohamedahmed, Ali Yasen Y
AU  - Mohamedahmed AYY
AD  - Department of General Surgery, Sandwell and West, Birmingham Hospitals NHS Trust, 
      Birmingham, UK.
FAU - Peterknecht, Elizabeth
AU  - Peterknecht E
AUID- ORCID: 0000-0003-2848-8848
AD  - Department of General Surgery, Sandwell and West, Birmingham Hospitals NHS Trust, 
      Birmingham, UK. elizabeth.peterknecht1@nhs.net.
FAU - Zakaria, Reza Md
AU  - Zakaria RM
AD  - Department of Obstetrics and Gynaecology, Glangwili General Hospital, 
      Carmarthenshire, UK.
FAU - Mohamedahmed, Saeed Y Y
AU  - Mohamedahmed SYY
AD  - Department of Obstetrics and Gynaecology, Atbara Teaching Hospital, Atbara, 
      Sudan.
FAU - Hajibandeh, Shahab
AU  - Hajibandeh S
AUID- ORCID: 0000-0002-3294-4335
AD  - Department of General Surgery, Glan Clwyd Hospital, Rhyl, Denbighshire, UK.
FAU - Hajibandeh, Shahin
AU  - Hajibandeh S
AUID- ORCID: 0000-0001-6159-1068
AD  - Department of General Surgery, Wye Valley NHS Trust, Hereford, UK.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20210707
PL  - Germany
TA  - Langenbecks Arch Surg
JT  - Langenbeck's archives of surgery
JID - 9808285
SB  - IM
MH  - *Cesarean Section/adverse effects
MH  - Female
MH  - Humans
MH  - Pregnancy
MH  - Randomized Controlled Trials as Topic
MH  - Surgical Instruments
MH  - Surgical Wound Infection/epidemiology/etiology
MH  - *Suture Techniques
MH  - Sutures
OTO - NOTNLM
OT  - Caesarean section
OT  - Clips
OT  - Skin closure
OT  - Sutures
EDAT- 2021/07/08 06:00
MHDA- 2022/02/19 06:00
CRDT- 2021/07/07 12:22
PHST- 2021/02/03 00:00 [received]
PHST- 2021/06/09 00:00 [accepted]
PHST- 2021/07/08 06:00 [pubmed]
PHST- 2022/02/19 06:00 [medline]
PHST- 2021/07/07 12:22 [entrez]
AID - 10.1007/s00423-021-02239-0 [pii]
AID - 10.1007/s00423-021-02239-0 [doi]
PST - ppublish
SO  - Langenbecks Arch Surg. 2022 Feb;407(1):37-50. doi: 10.1007/s00423-021-02239-0. 
      Epub 2021 Jul 7.