Cesarean section (CS) in obese women poses many surgical, anesthetic, and logistical challenges. This systematic review and meta-analysis aimed to compare the outcomes between staples versus subcuticular suture for cesarean skin closure in obese women undergoing CS.

PubMed, EMBASE and CENTRAL databases were searched for relevant articles using the keywords cesarean section, cesarean delivery, staple, suture, closure and obese. Randomized controlled trials (RCTs), prospective and retrospective studies comparing between staples and subcuticular suture for wound closure in obese women (BMI ≧ 30 kg/m2) were eligible for inclusion. Outcomes were composite wound complication, wound separation, infection and wound appearance satisfaction.

Four studies (two RCTs, one retrospective, one post hoc analysis of an RCT) met the inclusion criteria, with a total of 2,038 obese women undergoing CS, of whom 984 had wound closure by staples and 1,054 had wound closure by subcuticular suture. Pooled analysis did not show significant differences on the risk for composite wound complication, infection, wound appearance satisfaction score or wound separation between staples and sutures.

In obese women receiving CS, it appears there are no significant differences in wound complication, infection, satisfaction scores or wound separation between staples and subcuticular suture. These findings may help optimize risk stratification for obese CS patients. A larger study size meta-analysis is needed to confirm the findings.