Staples vs sutures in surgical wound closure: a comprehensive review

This systematic review and meta-analysis aimed to compare the effects of staples versus sutures for skin closure in various types of surgery, with a focus on wound infection rates, length of hospital stay, readmission rates, adverse events, and patient satisfaction with cosmetic results. The analysis included 42 randomized controlled trials (RCTs) involving a total of 11,067 adult patients. Across the studies, the evidence was insufficient to clearly demonstrate whether staples or sutures significantly reduce the overall risk of wound infection, with rates reported at 6.75% for staples and 4.90% for sutures (risk ratio [RR] 1.20, 95% confidence interval [CI] 0.80–1.79). Similarly, the evidence was inconclusive for severe wound infections, with no significant difference between the two methods.

However, some secondary outcomes provided more clarity. Sutures were associated with a lower risk of adverse events, with a 3.5% incidence compared to 7.3% for staples (RR 2.00, 95% CI 1.44–2.79), and patients treated with sutures reported greater satisfaction with the cosmetic results. Moreover, sutures were also linked to slightly reduced postoperative pain and a lower likelihood of readmission compared to staples. Despite these trends, the overall quality of evidence was low due to methodological limitations in the included studies, including issues with allocation concealment and blinding.

In conclusion, while sutures may offer some advantages in terms of cosmetic outcomes and reduced adverse events, the lack of high-quality evidence prevents a definitive recommendation between the two techniques for all surgical wound closures. Future high-quality, well-controlled studies are needed to further clarify the comparative benefits of staples versus sutures.