A Comparative Clinical Study of Skin Staples and Standard Suture for Closure of Abdominal Surgical Incisions

INTRODUCTION

Advancements in surgical techniques have emphasized improving wound closure to minimize complications and enhance outcomes. Sutures and staples are the most common methods, each with distinct advantages and limitations. Sutures, used since ancient times, offer precise tissue approximation but are time-consuming and require skill.^[1,2] Surgical staples, introduced in the mid-20th century, provide faster closure using biocompatible metals and are preferred in time-sensitive settings.^[3]

Choice of method depends on incision type, patient condition, and surgeon preference. Staples offer speed but may cause more discomfort during removal and have the potential for increased scarring. Sutures may yield better cosmetic results but prolong operative time.^[4] Previous studies comparing these methods show mixed results regarding infection rates, closure time, and patient satisfaction.^[5]

Cosmetic outcomes, particularly in abdominal surgeries, are critical and influenced by closure technique and postoperative care.^[6] Patient comfort also matters, with some finding staple removal more painful.^[7] Cost is another factor-while staples save time, they are costlier, impacting decisions in resource-limited settings.^[8] Overall, wound healing and scar quality are vital in evaluating closure efficacy.^[9,10]

This study compares sutures and staples in abdominal incision closure, focusing on closure time, infection rates, and cosmetic results to identify the superior method.

MATERIAL AND METHODS

This prospective observational study was conducted to compare the clinical outcomes of skin closure using sutures versus staples in abdominal surgeries. It was carried out in the Department of General Surgery at People’s College of Medical Sciences and Research Centre, Bhopal, involving patients from both emergency and elective surgeries. The study spanned over 24 months, from May 1, 2023, to April 1, 2025.

All patients undergoing abdominal surgeries who met the inclusion criteria and gave written informed consent were included. Inclusion criteria were patients aged between 18 and 65 years, undergoing abdominal surgeries requiring skin closure with either sutures or staples. Exclusion criteria included patients with lacerated wounds involving significant skin loss, uncontrolled diabetes or immunosuppression, burst abdomen, or cases where the surgeon declined participation.

A total of 108 cases were enrolled-60 underwent closure with sutures and 48 with staples. Allocation into the two groups was based on the operating surgeon’s choice, reflecting real-world practice. Both groups were evaluated for clinical outcomes using the same parameters. Independent variables included age, gender, residential background, education level, type and length of incision, wound class, duration of closure, and intraoperative difficulties such as bleeding, wound tension, skin alignment, and redundant skin. Dependent variables included post-operative complications like redness, edema, ecchymosis, pain during removal, hematoma, seroma, abscess, wound dehiscence, surgical site infection, scar appearance, hypertrophy, stiffness, and secondary changes such as discharge or ulcer.

Patients were monitored post-operatively on Days 0, 3, 5, 7, 14, and 30. Data were collected through medical records, direct observations, and patient interviews using a standardized proforma. Photographs of the surgical site were taken during follow-ups to document scar healing objectively. Infection and complications were confirmed through clinical signs and laboratory tests.

Data analysis was performed using statistical software. Continuous variables like closure time were analyzed with t-tests, while categorical variables like infection rates were assessed using chi-square tests. Descriptive statistics summarized demographic and clinical data, and multivariate analysis was used to adjust for confounding variables. All analyses were conducted at a 95% confidence level.

Ethical clearance was obtained from the Institutional Ethics Committee before initiating the study. Written informed consent was taken from each participant after explaining the purpose, procedures, risks, and benefits. Patient confidentiality was maintained, and participants had the right to withdraw at any point without affecting their medical care.

RESULTS

One hundred eight patients were enrolled in the study according to the type of skin closure (suture or staples) method used by the operating surgeon. The patients were divided into 2 groups, i.e., standard suture group (60 patients) and skin staple group (48 patients).

Age-wise, among those ≤30 years, 3 (6.3%) cases were closed with staples and 3 (5.0%) with sutures. In the 31–40 years age group, staples were used in 11 (22.9%) cases, and sutures in 8 (13.3%). The 41–50 years group included 12 (25.0%) staple closures and 22 (36.7%) suture closures. For ages 51–60 years, both groups had equal proportions: 12 (25.0%) staples and 15 (25.0%) sutures. In the 61–70 years category, staples were used in 10 (20.8%) and sutures in 12 (20.0%) cases. Despite variations in frequencies, the association between age group and closure method was not statistically significant (Chi-square = 2.629, p = 0.622).

Gender distribution showed that among males, 26 (54.2%) received staples and 36 (60.0%) received sutures. Among females, 22 (45.8%) received staples and 24 (40.0%) received sutures. The difference was not statistically significant (Chi-square = 0.371, p = 0.542), suggesting closure type was not influenced by gender.

When evaluating comorbidities, among diabetics, 13 (27.1%) received staples and 16 (26.7%) sutures. For hypertension, 16 (33.3%) in the staple group and 15 (25.0%) in the suture group were hypertensive. Thyroid disorders were present in 9 (18.8%) staple cases and 6 (10.0%) suture cases. Other comorbidities were reported in 4 (8.3%) of staple closures and 4 (6.7%) of suture closures. None of these differences were statistically significant (p-values > 0.05), indicating that comorbidities did not influence the closure technique.

Regarding the type of surgery, 40 (83.3%) of staple cases and 51 (85.0%) of suture cases were elective surgeries, while 8 (16.7%) in the staple group and 9 (15.0%) in the suture group were emergency procedures. The association was not significant (Chi-square = 0.056, p = 0.813) [Table 1].

For the type of incision, 35 (72.9%) staple cases and 45 (75.0%) suture cases involved midline incisions. Pfannenstiel incisions were seen in 7 (14.6%) staple cases and 12 (20.0%) suture cases. Transverse incisions accounted for 6 (12.5%) in the staple group and 3 (5.0%) in the suture group. The difference in incision type between groups was not statistically significant (Chi-square = 2.26, p = 0.323).

The present study compared various clinical parameters between suture and staple closure methods in abdominal surgeries. The mean incision length in the staples group was 13.28 ± 4.50 cm, slightly higher than the sutures group at 12.14 ± 4.86 cm, though this difference was not statistically significant (p = 0.211). A highly significant difference was observed in closure time, with the staples group showing a shorter mean closure duration of 7.17 ± 1.79 minutes compared to 13.93 ± 3.00 minutes in the sutures group (p = 0.000), indicating that staples allow for faster wound closure.

Wound healing time was comparable between both groups, with the sutures group healing in 13.10 ± 3.65 days and the staples group in 12.81 ± 3.96 days (p = 0.696), suggesting that the method of closure did not significantly affect healing duration. Similarly, the mean duration of hospital stay was 6.03 ± 2.07 days in the sutures group and 5.88 ± 1.93 days in the staples group (p = 0.685), indicating no notable difference in the overall recovery period.

Scar width was also found to be similar between the two methods, with the sutures group having a mean scar width of 3.09 ± 1.10 mm and the staples group 3.23 ± 1.10 mm (p = 0.512), reflecting comparable cosmetic outcomes. Postoperative pain assessment revealed that patients in the staples group experienced significantly less pain on Day 1 (4.40 ± 0.94) and Day 3 (2.38 ± 0.70) compared to the sutures group (6.33 ± 1.92 on Day 1 and 4.03 ± 1.66 on Day 3), with both differences being statistically significant (p = 0.000 for both). By Day 7, pain levels had decreased in both groups, with the sutures group reporting 2.07 ± 1.41 and the staples group 1.85 ± 1.41 (p = 0.439), showing no significant difference [Table 2].

The comparison of intraoperative and postoperative complications between suture and staple closure methods revealed that most clinical outcomes were similar in both groups, with a few notable differences. Intraoperative complications occurred in 8.3% of cases in the staples group and 5.0% in the sutures group. This difference was not statistically significant (p = 0.484), indicating that both methods are equally safe during the surgical procedure. Similarly, wound infection rates were almost identical—6.3% for staples and 6.7% for sutures (p = 0.930), suggesting no added infection risk with either method.

Skin gaping occurred in 6.3% of staple closures and 3.3% of suture closures (p = 0.474), and seroma formation was slightly more common with staples (10.4%) compared to sutures (8.3%) (p = 0.711); however, neither difference was statistically significant. Notably, hematoma formation was observed only in the suture group (5.0%) and not in any staple cases, though this difference did not reach statistical significance (p = 0.119).

A significant difference was observed in cosmetic outcomes. Good cosmetic results were reported in 75.0% of staple closures compared to 43.3% of suture closures, with a statistically significant association (p = 0.003). This suggests that staples may offer superior aesthetic outcomes in abdominal wound closure.

Hypertrophic scar formation was uncommon in both groups but slightly more frequent in the suture group (6.7%) than the staples group (2.1%), though this difference was not statistically significant (p = 0.260).

Lastly, patient satisfaction was significantly higher among those who underwent closure with staples. An excellent satisfaction score was reported by 41.7% of staple group cases compared to only 16.7% in the suture group (p = 0.030), highlighting better subjective acceptance of staples among patients [Table 3].

DISCUSSION

Abdominal incision closure is a vital step influencing healing, infection risk, and patient satisfaction. While sutures have traditionally been used, staples are gaining popularity for their faster application and better cosmetic results. This study aimed to compare both techniques across demographic, clinical, and surgical variables.

Demographic variables showed no significant difference in age or gender in relation to the choice of closure method (p > 0.05). Comorbidities like diabetes, hypertension, thyroid disorders, or others also showed no significant association with the type of closure used. Type of surgery and incision (elective/emergency and midline/Pfannenstiel/transverse) did not influence the choice of closure method significantly (p > 0.05).

Incision length did not differ significantly between the two groups (sutures: 12.14 ± 4.86 cm vs staples: 13.28 ± 4.50 cm; p = 0.211). Pain scores on Days 1 and 3 were significantly higher in the suture group (6.33 ± 1.92 and 4.03 ± 1.66) than in the staple group (4.40 ± 0.94 and 2.38 ± 0.70), while Day 7 showed no difference. Closure time was significantly shorter with staples (7.17 ± 1.79 min) compared to sutures (13.93 ± 3.00 min; p < 0.001), consistent with multiple studies. Staple closure was associated with shorter duration of surgery, whereas the two techniques appeared equivalent overall with regard to pain, cosmetics, and patient satisfaction.^{[11, 12]}

Complications such as wound infection, seroma, hematoma, and skin gaping showed no statistically significant difference between the groups, found higher complications in suture groups. Hospital stay did not differ significantly (sutures: 6.03 ± 2.07 days vs staples: 5.88 ± 1.93 days), reported shorter stays with staples. Cosmetic outcomes were significantly better in the staple group (75% good outcomes vs 43.3% in sutures; p = 0.003).

We conclude that skin staplers are superior to sutures in many respects, like better wound cosmesis, in reducing the postoperative pain, wound infection, and are very significant in saving time for skin closure.

Patient satisfaction was also significantly higher with staples (66.7% rated excellent or very good vs 41.7% in sutures; p = 0.03), skin closure by stapler can be preferred over conventional skin suture as it is easy to apply, takes significantly less time for application, easy to remove with less pain to the patients, provides better cosmetic outcome and is also cost-effective, Singh HR et al. Int Surg J. 2023^{[13, 14]}

CONCLUSION

The present study comprehensively compared skin staples and sutures for abdominal wound closure across multiple parameters, including demographic characteristics, intraoperative factors, postoperative outcomes, complications, cosmetic results, and patient satisfaction. Statistically significant differences were observed in closure time, postoperative pain (particularly on Day 1 and Day 3), cosmetic outcomes, and patient satisfaction. Closure with skin staples was significantly faster, associated with less early postoperative pain, and resulted in better cosmetic appearance and higher patient satisfaction scores compared to sutures. The findings demonstrated no statistically significant difference between the two methods in terms of demographic distribution, comorbidities, type of surgery, type of incision, incision length, hospital stay duration, or postoperative complications such as wound infection, seroma, hematoma, or skin gaping.

These results suggest that while both methods are clinically safe and effective, skin staples may offer advantages in terms of efficiency, early comfort, and cosmetic satisfaction. Therefore, skin staples can be considered a preferable alternative to sutures for abdominal incision closure, particularly in settings where rapid closure and improved aesthetic outcomes are desired.