STAPLERS VERSUS SUTURES FOR SKIN CLOSURE IN ELECTIVE ABDOMINAL SURGERIES: A RANDOMISED COMPARATIVE STUDY OF EFFICIENCY, SURGICAL SITE INFECTION, AND SCAR OUTCOME

Abstract

Background: Skin closure is the final, and cosmetically most visible, step of elective abdominal surgery. The technique chosen influences operative efficiency, wound complications, patient comfort, and cosmetic outcome. Mechanical skin staplers offer rapid, standardised closure, whereas hand-placed sutures allow precise tissue apposition, but comparative evidence between the two in the Indian surgical setting remains limited. Objectives: To compare skin staplers with interrupted non-absorbable sutures for closure time; 30-day surgical site infection (SSI) rate and wound dehiscence; scar quality on the Vancouver Scar Scale (VSS) at 2, 4 and 8 weeks; and postoperative pain and patient satisfaction. Methods: This prospective, open-label, randomised comparative study was conducted in the Department of General Surgery, Saveetha Medical College and Hospital, after institutional ethical clearance. Sixty adults (18–65 years, ASA I III, BMI <35 kg/m², CDC wound Class I/II) undergoing elective midline laparotomy were randomised equally to skin closure with a disposable mechanical skin stapler (Group A, n=30) or interrupted 2-0 polypropylene sutures (Group B, n=30). Closure time, 30-day SSI rate (CDC criteria), wound dehiscence, numeric rating scale (NRS) pain, VSS score, patient satisfaction (5-point Likert scale) and length of stay were recorded. Results: Baseline characteristics were comparable between groups (p>0.05). Closure time was significantly shorter with staplers (4.2 vs 11.8 min; p<0.001). SSI (8.3% vs 21.7%; p=0.04) and dehiscence (6.7% vs 13.3%; p=0.03) were lower, and complete closure was higher (91.7% vs 78.3%), with staplers. NRS pain at 48 hours (3.1 vs 4.8; p=0.002) and VSS at 8 weeks (1.4 vs 2.9; p=0.01) favoured staplers, as did patient satisfaction (4.3 vs 3.6/5; p=0.03). Length of stay was comparable (p=0.21). Conclusion: Skin staplers were significantly superior to sutures in closure time, SSI rate, wound dehiscence, postoperative pain, scar outcome and patient satisfaction in elective midline laparotomy, and their routine use is recommended where cosmetic precision is not the overriding concern.