Abstract
Background Staples have been widely used for skin closure after open gastrointestinal surgery. The potential advantages of subcuticular sutures compared with staples have not been assessed. We assessed the differences in the frequency of wound complications, including superficial incisional surgical site infection and hypertrophic scar formation, depending on whether subcuticular sutures or staples are used. Methods We did a multicentre, open-label, randomised controlled trial at 24 institutions between June 1, 2009, and Feb 28, 2012. Eligible patients aged 20 years or older, with adequate organ function and undergoing elective open upper or lower gastrointestinal surgery, were randomly assigned preoperatively to either staples or subcuticular sutures for skin closure. Randomisation was done via a computer-generated permuted-block sequence, and was stratified by institution, sex, and type of surgery (ie, upper or lower gastrointestinal surgery). Our primary endpoint was the incidence of wound complications within 30 days of surgery. Analysis was done by intention to treat. This study is registered with UMINCTR, UMIN000002480. Findings 1080 patients were enrolled and randomly assigned in a one to one ratio: 562 to subcuticular sutures and 518 to staples. 1072 were eligible for the primary endpoint and 1058 for the secondary endpoint. Of the 558 patients who received subcuticular sutures, 382 underwent upper gastrointestinal surgery and 176 underwent lower gastrointestinal surgery. Wound complications occurred in 47 of 558 patients (8·4%, 95% CI 6·3-11·0). Of the 514 who received staples, 413 underwent upper gastrointestinal surgery and 101 underwent lower gastrointestinal surgery. Wound complications occurred in 59 of 514 (11·5%, 95% CI 8·9-14·6). Overall, the rate of wound complications did not differ significantly between the subcuticular sutures and staples groups (odds ratio 0·709, 95% CI 0·474-1·062; p=0·12). Interpretation The efficacy of subcuticular sutures was not validated as an improvement over a standard procedure for skin closure to reduce the incidence of wound complications after open gastrointestinal surgery.
| Original language | English |
|---|---|
| Pages (from-to) | 1105-1112 |
| Number of pages | 8 |
| Journal | The Lancet |
| Volume | 382 |
| Issue number | 9898 |
| DOIs | |
| Publication status | Published - Jan 1 2013 |
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All Science Journal Classification (ASJC) codes
- Medicine(all)
Cite this
Subcuticular sutures versus staples for skin closure after open gastrointestinal surgery : A phase 3, multicentre, open-label, randomised controlled trial. / Tsujinaka, Toshimasa; Yamamoto, Kazuyoshi; Fujita, Junya; Endo, Shunji; Kawada, Junji; Nakahira, Shin; Shimokawa, Toshio; Kobayashi, Shogo; Yamasaki, Makoto; Akamaru, Yusuke; Miyamoto, Atsushi; Mizushima, Tsunekazu; Shimizu, Junzo; Umeshita, Koji; Ito, Toshinori; Doki, Yuichiro; Mori, Masaki.
In: The Lancet, Vol. 382, No. 9898, 01.01.2013, p. 1105-1112.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Subcuticular sutures versus staples for skin closure after open gastrointestinal surgery
T2 - A phase 3, multicentre, open-label, randomised controlled trial
AU - Tsujinaka, Toshimasa
AU - Yamamoto, Kazuyoshi
AU - Fujita, Junya
AU - Endo, Shunji
AU - Kawada, Junji
AU - Nakahira, Shin
AU - Shimokawa, Toshio
AU - Kobayashi, Shogo
AU - Yamasaki, Makoto
AU - Akamaru, Yusuke
AU - Miyamoto, Atsushi
AU - Mizushima, Tsunekazu
AU - Shimizu, Junzo
AU - Umeshita, Koji
AU - Ito, Toshinori
AU - Doki, Yuichiro
AU - Mori, Masaki
PY - 2013/1/1
Y1 - 2013/1/1
N2 - Background Staples have been widely used for skin closure after open gastrointestinal surgery. The potential advantages of subcuticular sutures compared with staples have not been assessed. We assessed the differences in the frequency of wound complications, including superficial incisional surgical site infection and hypertrophic scar formation, depending on whether subcuticular sutures or staples are used. Methods We did a multicentre, open-label, randomised controlled trial at 24 institutions between June 1, 2009, and Feb 28, 2012. Eligible patients aged 20 years or older, with adequate organ function and undergoing elective open upper or lower gastrointestinal surgery, were randomly assigned preoperatively to either staples or subcuticular sutures for skin closure. Randomisation was done via a computer-generated permuted-block sequence, and was stratified by institution, sex, and type of surgery (ie, upper or lower gastrointestinal surgery). Our primary endpoint was the incidence of wound complications within 30 days of surgery. Analysis was done by intention to treat. This study is registered with UMINCTR, UMIN000002480. Findings 1080 patients were enrolled and randomly assigned in a one to one ratio: 562 to subcuticular sutures and 518 to staples. 1072 were eligible for the primary endpoint and 1058 for the secondary endpoint. Of the 558 patients who received subcuticular sutures, 382 underwent upper gastrointestinal surgery and 176 underwent lower gastrointestinal surgery. Wound complications occurred in 47 of 558 patients (8·4%, 95% CI 6·3-11·0). Of the 514 who received staples, 413 underwent upper gastrointestinal surgery and 101 underwent lower gastrointestinal surgery. Wound complications occurred in 59 of 514 (11·5%, 95% CI 8·9-14·6). Overall, the rate of wound complications did not differ significantly between the subcuticular sutures and staples groups (odds ratio 0·709, 95% CI 0·474-1·062; p=0·12). Interpretation The efficacy of subcuticular sutures was not validated as an improvement over a standard procedure for skin closure to reduce the incidence of wound complications after open gastrointestinal surgery.
AB - Background Staples have been widely used for skin closure after open gastrointestinal surgery. The potential advantages of subcuticular sutures compared with staples have not been assessed. We assessed the differences in the frequency of wound complications, including superficial incisional surgical site infection and hypertrophic scar formation, depending on whether subcuticular sutures or staples are used. Methods We did a multicentre, open-label, randomised controlled trial at 24 institutions between June 1, 2009, and Feb 28, 2012. Eligible patients aged 20 years or older, with adequate organ function and undergoing elective open upper or lower gastrointestinal surgery, were randomly assigned preoperatively to either staples or subcuticular sutures for skin closure. Randomisation was done via a computer-generated permuted-block sequence, and was stratified by institution, sex, and type of surgery (ie, upper or lower gastrointestinal surgery). Our primary endpoint was the incidence of wound complications within 30 days of surgery. Analysis was done by intention to treat. This study is registered with UMINCTR, UMIN000002480. Findings 1080 patients were enrolled and randomly assigned in a one to one ratio: 562 to subcuticular sutures and 518 to staples. 1072 were eligible for the primary endpoint and 1058 for the secondary endpoint. Of the 558 patients who received subcuticular sutures, 382 underwent upper gastrointestinal surgery and 176 underwent lower gastrointestinal surgery. Wound complications occurred in 47 of 558 patients (8·4%, 95% CI 6·3-11·0). Of the 514 who received staples, 413 underwent upper gastrointestinal surgery and 101 underwent lower gastrointestinal surgery. Wound complications occurred in 59 of 514 (11·5%, 95% CI 8·9-14·6). Overall, the rate of wound complications did not differ significantly between the subcuticular sutures and staples groups (odds ratio 0·709, 95% CI 0·474-1·062; p=0·12). Interpretation The efficacy of subcuticular sutures was not validated as an improvement over a standard procedure for skin closure to reduce the incidence of wound complications after open gastrointestinal surgery.
UR - http://www.scopus.com/inward/record.url?scp=84884659214&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84884659214&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(13)61780-8
DO - 10.1016/S0140-6736(13)61780-8
M3 - Article
C2 - 24075050
AN - SCOPUS:84884659214
VL - 382
SP - 1105
EP - 1112
JO - The Lancet
JF - The Lancet
SN - 0140-6736
IS - 9898
ER -