Stapler Group Research Articles

Dorsal locking plates versus staples in four-corner fusion: A comparative clinical and radiological study

IntroductionFour-corner fusion was described in 1984 by HK Watson for the treatment of SLAC wrist. This intervention has undergone few changes since that description, but the debate on the fixation method is still not resolved. HypothesisDorsal locking plates provide better stability, short immobilization and a quicker return to daily activities than traditional fixation methods such as staples. Materials and methodsThirty-one fusions using the Medartis Aptus Four-Corner Fusion® plate at a mean 13.1months’ follow-up and 35 using staples at a mean 80.4months’ follow-up were reviewed in a clinical and radiographic retrospective comparative study. ResultsResults were comparable between the two groups in terms of range of motion (flexion-extension arc of 67.3° for plates and 60.6° for staples), force (29.6 and 28kg.F), pain and disability (PRWE 34.8/150 and 40.9; QuickDASH 19.83/100 and 30). Mean time off work was significantly shorter in the plate group (4.5 vs. 7.9months). There were no non-unions in the plate group, versus 2 in the staples group. Dorsal impingement implicating hardware was also less frequent in the plate group (2 vs. 11). DiscussionThe dorsal locking plate did not improve final results in four-corner fusion in terms of range of motion, force, pain or function compared to staples. However, it provided stable fixation, allowing a shorter immobilization and a quicker return to work. Although the initial cost is higher, it could allow significant savings on postoperative costs, shifting the technical debate into the field of public health. Level of evidenceLevel IV, retrospective study.

English

OBJECTIVES: The objectives of this study were to study the total cost and operative time required for suture and staple Repairs, to study the effect on wound healing and infection rate with the use of Sutures and staples, to study the cosmetic results of these two techniques and to study the degree of patient's acceptance with the two techniques. MATERIALS AND METHODS: Source of Data: The study was conducted on 100 patients who undergoing elective surgery from January 2010 to March 2014 in BLDE UNIVERSITY, Shri B M Patil medical college Bijapur. The patients were randomly selected to receive either suture or staple repair. METHOD OF COLLECTION OF DATA: DURING OPERATION- from operating surgeon. Post operatively: from patient's input. Supply of Suture and Staples: from pharmacy. FOLLOW UP OF PATIENTS: Patients came for follow up to out- patient Department After discharge. INCLUSION CRITERIA: Patients undergoing elective abdominal surgery, with clean wound. EXCLUSION CRITERIA: Patients having lacerated wounds with skin loss. RESULT: The study groups included 100 patients who underwent wound closure by staplers and 100 patients who underwent the silk suturing. The youngest patient was aged 2 year and the oldest was 75 years old. The commonest region of the surgical wounds in this study was inguinal, 20 in staplers and 20 in suture group. The time taken for wound closure using staplers showed statistically significant difference over silk suture closure. It took the stapler four times less duration to perform wound closure. The appearance of the scar among the staple groups was good in 90% of those who returned for follow up at one month, 10% had average scar. The average cost of using staple was higher than silk suture. Patient acceptance was better in the staple group with less pain during removal as compared to suture group. There were four complications in the staple group in the form of wound infection and ten cases of postoperative wound infection in the suture group. Average VAS of patients in staple group at the end of one month was 71.88 (±5.50) while the average for suture group was 64.44(±6.17). P value calculated using Student's Unpaired 'T' test. P value was <0.0001 which was highly significant.

Is hand sewing comparable with stapling for anastomotic leakage after esophagectomy? A meta-analysis.

To compare the outcome of hand sewing and stapling for anastomotic leakage after esophagectomy. A rigorous study protocol was established according to the recommendations of the Cochrane Collaboration. An electronic database search, hand search, and reference search were used to retrieve all randomized controlled trials that compared hand-sewn and mechanical esophagogastric anastomoses. This study included 15 randomized controlled trials with a total of 2337 patients. The results revealed that there was no significant difference in the incidence of anastomotic leakage between the methods [relative risk (RR) = 0.77, 95% confidence interval (CI): 0.57-1.04; P = 0.09], but a subgroup analysis yielded a significant difference for the sutured layer and year of publication (Ps < 0.05). There was also no significant difference in the incidence of postoperative mortality (RR = 1.52, 95%CI: 0.97-2.40; P = 0.07). However, the anastomotic strictures rate was increased in the stapler group compared with the hand-sewn group (RR = 1.45, 95%CI: 1.11-1.91; P < 0.01) in the end-to-side subgroup, while the incidence of anastomotic strictures was decreased (RR = 0.34, 95%CI: 0.16-0.76; P < 0.01) in the side-to-side subgroup. The stapler reduces the anastomotic leakage rate compared with hand sewing. End-to-side stapling increases the risk of anastomotic strictures, but side-to-side stapling decreases the risk.

A prospective randomized comparison of two skin closure techniques in acetabular fracture surgery

BackgroundRecent publications have shown an infection rate of 5–7 % for acetabular fractures treated with the Kocher-Langenbeck (K-L) approach. Using metallic staples to close hip skin incisions has been considered the gold standard. The purpose of this study was to answer the following: (1) will closure of a K-L incision after acetabular fracture surgery with a running subcuticular monocryl suture, then sealing the wound with 2-octyl cyanoacrylate (OCA), result in a lower infection rate compared to metallic staple closure? (2) Do incisions closed with subcuticular monocryl and OCA exhibit decreased drainage? (3) Is there a cost difference between these two methods?Materials and methodsIn a prospective clinical study, 103 patients with acetabular fractures treated using the K-L approach were randomized into two groups: skin closure with metallic staples (n = 52) versus subcuticular running monocryl suture sealed with OCA (n = 51).ResultsTwo postoperative deep infections (4 %) in the staples group required multiple debridements; no infections developed in the OCA group. However, there was no statistical difference between the groups, (p = 0.495). There was a statistically significant difference (p = 0.032) comparing days from surgery to a dry incision favoring OCA (4.2 versus 5.85 days). The patient charge was approximately $900 greater on average in the OCA group due to the increased time in the operating room required for the subcuticular closure.ConclusionsClosure with OCA and subcuticular monocryl showed no clinical disadvantages and appears to have a clinical advantage when compared to standard metallic staple skin closure in acetabular fracture surgery. However, additional patient costs may be incurred.Level of evidenceII.

Analysis of endoloops and endostaples for closing the appendiceal stump during laparoscopic appendectomy

An inadequate closure of the appendiceal stump can lead to intra-abdominal surgical site infections. The aim of this study was to assess the efficiency of different closure techniques by focusing on the intraoperative and postoperative complications versus cost. From June 2011 to June 2013, 333 patients from two different hospitals undergoing laparoscopic appendectomy were included in this study. The patients were divided into two groups based on the technique used for appendiceal stump closure: there were 104 patients in the stapler group and 229 in the loop group. Among the 333 patients who underwent laparoscopic appendectomy, there were two (0.6%) intraoperative complications and 22 (6.6%) postoperative complications. There were no significant differences between the groups with respect to the intraoperative and postoperative complications. The length of the operation was 7 min shorter when the endoloop was used (p = 0.014). The mean costs of the operation were significantly lower when the loop was used (<euro> 554.93) compared to the stapler (<euro> 900.70) (p = 0.000). There is no clinical evidence supporting the routine use of endoscopic staplers. The appendiceal stump can be secured safely with the use of endoloops in the majority of patients. Surgeons have to be more selective when choosing how to perform closure, and an endostapler should be used only in cases where it is clinically indicated.

Risk Factors for Wound Complications After Surgery for Gynecologic Malignancies

Factors in wound complications such as surgical duration and suture methods are surgeon-side problems. The purpose of the present study was to retrospectively evaluate the incidence of wound complications in patients who underwent wound closure with stainless steel staples or subcuticular sutures in surgery for gynecologic malignancies and to retrospectively determine the risk factors for wound complications. From April 2007 through March 2012, a cohort of 317 consecutive patients undergoing surgery for gynecologic malignancies was evaluated in the retrospective study. The skin was closed with stainless steel staples before March 2010 (staples group). From April 2010, the skin was closed by subcuticular suturing (subcuticular group). We compared the incidence of wound complications between 2 groups and evaluated independent multivariate associations with the effect of clinical parameters on occurrence of wound complications. The incidence of wound disruption was 7.3% (23/317): 12.1% (17/140) in the staples group and 3.4% (6/177) in the subcuticular group (P = 0.0029). The incidence of wound infection was 2.5% (8/317): 5.0% (7/140) in the staples group and 0.6% (1/177) in the subcuticular group (P = 0.0124). Multivariate analyses performed with wound disruption as the end point revealed long-term steroid treatment, subcutaneous thickness, and skin staples as independent predictors. Subcutaneous thickness and skin staples were independent factors significantly associated with the possibility of wound infection. The findings of the present study indicated that risk factors for wound complications after surgeries for gynecologic malignancies include, as a surgeon-side problem, the use of staples for skin closure, and as a patient-side problem, a subcutaneous thickness of more than 30 mm.

Results of Li-Tho trial: a prospective randomized study on effectiveness of LigaSure(R) in lung resections

The role of electro-thermal bipolar tissue sealing system (LigaSure(®), (LS); Covidien, Inc., CO, USA) in thoracic surgery is still undefined. Reports of its use are still limited. The objective of the trial was to evaluate the cost and benefits of LS in major lung resection surgery. A randomized blinded study of a consecutive series of 100 patients undergoing lobectomy was undertaken. After muscle-sparing thoracotomy and classification of lung fissures according to Craig-Walker, patients with fissure Grade 2-4 were randomized to Stapler group or LS group fissure completion. Recorded parameters were analysed for differences in selected intraoperative and postoperative outcomes. Statistical analysis was performed with the bootstrap method. Pearson's χ(2) test and Fisher's exact test were used to calculate probability value for dichotomous variables comparison. Cost-benefit evaluation was performed using Pareto optimal analysis. There were no significant differences between groups, regarding demographic and baseline characteristics. No patient was withdrawn from the study; no adverse effect was recorded. There was no mortality or major complications in both groups. There were no statistically significant differences as to operative time or morbidity between patients in the LS group compared with the Stapler group. In the LS group, there was a not statistically significant increase of postoperative air leaks in the first 24 postoperative hours, while a statistically significant increase of drainage amount was observed in the LS group. No statistically significant difference in hospital length of stay was observed. Overall, the LS group had a favourable multi-criteria analysis of cost/benefit ratio with a good 'Pareto optimum'. LS is a safe device for thoracic surgery and can be a valid alternative to Staplers. In this setting, LS allows functional lung tissue preservation. As to costs, LS seems equivalent to Staplers.

Staplers versus hand-sewing for pulmonary lobectomy: randomized controlled trial

Division of the parenchymal lung for lobectomy is performed in patients who have an incomplete fissure. A stapler device can reduce postoperative air leak, but it is expensive. to investigate the advantage of using a stapler, in terms of postoperative air leak and cost, compared to hand-sewn techniques. A Non-blinded randomized controlled trial was conducted in Chiang Mai University Hospital, Thailand, from November 15, 2011 to September 30, 2012. Fifty-three adult patients were randomized to undergo a hand-sewn technique (27 patients) or stapler closure (26 patients). Postoperative air leak in the stapler group was less than that in the hand-sewn group (7.7% vs. 29.6%, p = 0.044), and the duration of air leak in the stapler group was significantly shorter than that in the hand-sewn group (1.0 vs. 13.4 days, p = 0.032). The cost of treatment was not significantly different between groups; however, the total cost in the stapler group was less than that in the hand-sewn group (mean difference 4454 Thai baht (US$144.75). A stapler reduces postoperative air leaks and the duration of air leaks. Furthermore, the total cost of treatment was comparable. Therefore, using staples may provide substantial financial benefits.

Comparison of Complication Rates Associated with Stapling and Traditional Suture Closure after Total Laryngectomy for Advanced Cancer

We conducted a retrospective, matched-cohort, case-control study to compare complication rates associated with two wound closure procedures-stapling vs. traditional hand suturing-following total laryngectomy. Our study population was made up of 42 consecutively presenting patients-38 men and 4 women, aged 34 to 92 years (mean: 60.3) whose pharyngotomies were amenable to primary closure. Of this group, 37 patients had active endolaryngeal squamous cell carcinoma (SCC), 2 patients had inactive endolaryngeal SCC, 2 patients had thyroid cancer, and 1 patient had been treated for chronic aspiration. A total of 26 patients (61.9%) had undergone traditional suture closure of the neopharynx (suture group) and 16 patients (38.1%) had undergone closure with a linear stapling device (staple group). Other than the fact that the patients in the staple group were significantly older than those in the suture group (median: 71.0 vs. 56.5 yr, p = 0.002), there were no significant differences between the two groups in terms of comorbidities or cricopharyngeal myotomy, tracheoesophageal puncture, or neck dissection. There was a total of 8 postoperative infections-5 in the staple group (31.3%) and 3 in the suture group (11.5%)-not a statistically significant difference. Fistulas occurred in 4 staple patients (25.0%) and 6 suture patients (23.1%)-again, not statistically significant. We conclude that in appropriately selected patients, primary closure of the neopharynx can be safely and effectively achieved with a linear stapling device.

Application of nickel titanium compression anastomosis clip in gastrointestinal anastomosis

Objective To investigate the efficacy and safety of nickel titanium compression anastomosis clip (CAC) in gastrointestinal anastomosis.Methods The clinical data of 413 patients who received gastrointestinal anastomosis with nickel titanium CAC or curved stapler at the First Affiliated Hospital of Fujian Medical University from January 2007 to December 2011 were retrospectively analyzed.All the patients were divided into the CAC group (227 patients) and the curved stapler group (186 patients).The time for gastrointestinal anastomosis,anastomotic bleeding,complications,condition of the incision sites,the first postoperative flatus and time for the excretion of the CAC between the 2 groups were compared.All data were analyzed using the t test or chisquare test.Results The time for gastrointestinal anastomosis of the CAC group was (8.3 ± 2.5) minutes,which was significantly shorter than (18.7 ± 3.6) minutes of the curved stapler group (t =5.74,P ＜ 0.05).There were no significant difference in the time of postoperative flatus,duration of hospital stay and costs between the 2 groups (t =0.27,1.32,3.11,P ＞ 0.05).No patients in the CAC group had anastomotic bleeding,while the incidence of anastomotic bleeding of the curved stapler group was 3.23 ％ (6/186),with a significant difference between the 2 groups (x2=7.43,P ＜ 0.05).The incidences of gastric emptying dysfunction of the CAC group and the curved stapler group were 0.88％ (2/227) and 1.08％ (2/186),with no significant difference between the 2 groups (x2=0.04,P ＞ 0.05).The incidences of postoperative anastomotic stricture and anastomositis were 0 (0/227) and 11.01％ (25/227) in the CAC group,and 2.15％ (4/186) and 21.50％ (40/186) in the curved stapler group,with significant differences between the 2 groups (x2 =4.93,8.49,P ＜ 0.05).No anastomotic fistula was detected in the 2 groups.The CAC was excreted at postoperative day 12-26.Conclusion CAC is safe and effective for gastrointestinal anastomosis. Key words: Gastrointestinal diseases; Gastrointestinal anastomosis; Nickel titanium compression anastomosis clip; Curved stapler

Skin closure after laparotomy with staples or sutures: a study of the mature scar

Surgeons are divided in their method of choice for skin closure following laparotomy. We suggest that the most important determinant should be the resulting scar. This study aims to compare both patients' and independent observers' assessment of mature laparotomy scars that had been closed with either subcuticular sutures or external staples. Consecutive patients were enrolled at least 1 year following colorectal surgery. Scars were assessed with the validated Patient and Observer Scar Assessment Scoring (POSAS) tool. Photographs were assessed by a blinded independent panel. Overall, 232 patients were enrolled (90 suture, 143 staples). The two groups were well matched by factors affecting wound healing. Patients' overall opinion of their scar was significantly better for the Suture group than the Staples group (P = 0.028) despite there being no difference in their self-assessment of the components of their scar score (pain, itch, colour, stiffness, thickness, irregularity). The panel recorded similar overall scores for the Suture and Staples groups (P = 0.059). There was a significant lower (better) score recorded for the scar area component for the Suture group than the Staples group (P = 0.008) but no differences for the other components (vascularity, pigmentation or thickness). This study has shown that independent of skin closure method, patients who have undergone major abdominal surgery have a positive opinion of their mature scars. The patients' overall impression of the wound favours a sutured closure due to a smaller scar area (no staple marks). In all other respects, skin closure with staples would appear acceptable.

Comparison of two different transection techniques in liver surgery—an experimental study in a porcine model

Postoperative morbidity and mortality after liver resection is closely related to the degree of intraoperative blood loss; the majority of which occurs during transection of the liver parenchyma. Many approaches and devices have therefore been developed to limit bleeding, but none has yet achieved perfect results up to now. The aim of this standardized chronic animal study was to compare the safety and efficacy of the LigaSure™ Vessel Sealing System (LVSS) with the stapler technique, which is one of the modern techniques for transecting the parenchyma in liver surgery. Sixteen pigs underwent a left liver resection (LLR). Eight pigs received a LLR by means of an Endo GIA, whereas the other eight pigs underwent liver parenchymal transection followed by simultaneous sealing by the LVSS. The operating time, transection time, blood loss during transection, and time of hemostasis were measured on the day of LLR (postoperative day 0/POD 0). Animals were re-explored on postoperative day 7 (POD 7) and the transection surface of remnant liver was observed for fluid collection (hematoma, biloma, and abscess), necrosis, and other pathologies. A biopsy was taken from the area of transection for histopathological examination. All animals survived until POD 7. Operating time and transection time of the liver parenchyma on POD 0 was significantly shorter in the stapler group. There was no significant difference between the two groups in terms of blood loss during transection, time of hemostasis and number of sutures for hemostasis on POD 0, morbidity rate, as well as the histopathological examination on POD 7. Furthermore, the material costs were significantly higher in the stapler group than in the LVSS group. In this standardized chronic animal study concerning transection of the parenchyma in liver surgery, LVSS seems not only to be safe, but also comparable with the stapler technique in terms of morbidity and mortality. Additionally, LVSS significantly reduces material costs. However, the transection time is significantly longer for LVSS than for the stapler resection technique.

Efficacy of stapler pharyngeal closure after total laryngectomy: A systematic review

Some primary studies compare manual and mechanical pharyngeal closures after total laryngectomy. The purpose of this study was to evaluate the advantages of the mechanical suture in pharyngeal closure. The literature survey included research in MEDLINE, EMBASE, and LILACS. The intervention analyzed was stapler-assisted pharyngeal closure, whereas the control group was manual suture pharyngeal closure. The survey resulted in 319 studies. However, 4 studies were selected (417 patients). In the group of patients in whom the stapler was used, the incidence of pharyngocutaneous fistula was 8.7%, whereas in the other, it was 22.9%, with an absolute risk reduction of 15% (95% confidence interval [CI], 0.02-0.28; p = .02; I(2) = 66%). Regarding the surgical time, the average difference was 80 minutes in favor of the stapler group (95% CI, 23.16-136.58 minutes; p < .006). The difference for starting oral feeding was 8 days in favor of the mechanical suture (95% CI, 4.01-11.73 days; p < .001). Patients who underwent mechanical suture had a shorter hospitalization period.

Stapled versus hand-sewn anastomoses in emergency general surgery: A retrospective review of outcomes in a unique patient population

BACKGROUND: Recent studies have identified unique clinical and physiologic characteristics of emergency general surgery (EGS) patients and called for outcomes data in this population. There are no data in the US literature analyzing the impact of technique on anastomotic failure rates in EGS patients. The purpose of the current study was to compare outcomes of hand-sewn (HS) versus stapled (ST) bowel anastomoses in EGS patients. METHODS: A retrospective chart review of all patients admitted by our EGS service undergoing bowel resection for emergent indications from January 2007 to July 2011 was performed. Time from surgery to diagnosis of anastomotic failure was recorded as were the diagnostic modality and treatment of each anastomotic failure. Specific data on damage-control techniques, if used, were also collected. RESULTS: There were 100 HS (43%), and 133 ST (57%) anastomoses in 231 patients. Operative times were shorter in ST anastomosis technique (205 minutes for HS vs. 193 minutes for ST, p = 0.02). Anastomotic failures were identified in 26 patients (11%) and were significantly higher in the ST group than the HS group (15.0% vs. 6.1%, p = 0.003). A multivariate logistic regression analysis, controlling for age and preoperative nutritional status, revealed ST technique to be an independent risk factor for anastomotic failure (odds ratio, 2.65; 95% confidence interval, 1.08–6.50; p = 0.034). CONCLUSION: Anastomotic failures are more than twice as likely with ST than HS anastomoses in the EGS population. This is true even when controlling for markers of preoperative nutrition and demographics. These data suggest that the HS anastomosis should be the preferred method of reconstruction after bowel resection in EGS patients. LEVEL OF EVIDENCE: Therapeutic study, level IV.

Stapled versus hand-sewn anastomoses in emergency general surgery

Recent studies have identified unique clinical and physiologic characteristics of emergency general surgery (EGS) patients and called for outcomes data in this population. There are no data in the US literature analyzing the impact of technique on anastomotic failure rates in EGS patients. The purpose of the current study was to compare outcomes of hand-sewn (HS) versus stapled (ST) bowel anastomoses in EGS patients. A retrospective chart review of all patients admitted by our EGS service undergoing bowel resection for emergent indications from January 2007 to July 2011 was performed. Time from surgery to diagnosis of anastomotic failure was recorded as were the diagnostic modality and treatment of each anastomotic failure. Specific data on damage-control techniques, if used, were also collected. There were 100 HS (43%), and 133 ST (57%) anastomoses in 231 patients. Operative times were shorter in ST anastomosis technique (205 minutes for HS vs. 193 minutes for ST, p = 0.02). Anastomotic failures were identified in 26 patients (11%) and were significantly higher in the ST group than the HS group (15.0% vs. 6.1%, p = 0.003). A multivariate logistic regression analysis, controlling for age and preoperative nutritional status, revealed ST technique to be an independent risk factor for anastomotic failure (odds ratio, 2.65; 95% confidence interval, 1.08-6.50; p = 0.034). Anastomotic failures are more than twice as likely with ST than HS anastomoses in the EGS population. This is true even when controlling for markers of preoperative nutrition and demographics. These data suggest that the HS anastomosis should be the preferred method of reconstruction after bowel resection in EGS patients.

Is bipolar thermofusion an acceptable option for unseparated interlobar fissure division in pulmonary lobectomy?†

This study aimed to review the safety of a reusable sealing instrument, BiClamp(®), as an alternative to the mechanical stapler for interlobar fissure division in pulmonary lobectomy. A retrospective review was conducted of 95 patients who underwent pulmonary lobectomy performed by a single surgeon between November 2005 and March 2010. The patients were divided into two groups according to the period before and after introduction of the BiClamp(®): 29 patients who underwent fissure division with staples only (staple group) and 66 patients who underwent the same procedure mainly with the instrument (BiClamp(®) group). There were 60 (63.2%) male and 35 (36.8%) female patients, with a mean ± SD age of 67.5 ± 10.8 years. Comparison of the characteristics of the two groups revealed that the BiClamp(®) group included significantly more cases of lobectomy by video-assisted thoracic surgery and far fewer completely lobulated lungs; 6 of 66 patients (9.1%) compared with 9 of 29 (31.0%) of the staple group. Except for 18 patients who underwent division using staples owing to thick parenchyma of the interlobar fissure, we attempted to divide the fissure of 42 patients in the BiClamp(®) group. Solo use of the BiClamp(®) was possible for 25 of 60 patients (41.7%) with an incomplete fissure. Eight patients (13.3%) needed one staple cartridge in combination with BiClamp(®), five (8.3%) needed two cartridges and four (6.7%) patients needed three (combined use). In most cases, except for right upper or middle lobectomy, the division of the interlobar fissure could be performed by sole use of the BiClamp(®). Incidence rates of prolonged air leakage and pneumonia were not significantly different between the two groups (respectively, 6.9 and 3.4% in the staple group vs 10.6 and 9.1% in the BiClamp(®) group). The study results demonstrate that the division of the interlobar fissure in pulmonary lobectomy with BiClamp(®) is safe and feasible in most cases. While the results point out the limitation that division of the right upper or middle lobe may still be a challenge, they show the potential benefit of staple reduction. Less use of staples results in reduced medical costs and carbon dioxide emission, contributing to 'ecosurgery', which ultimately conserves the global environment.

Recurrence and chronic pain after mesh fixation with skin staples versus sutures in Lichtenstein’s inguinal hernioplasty: a retrospective cohort study

Reduction in operating time has been reported with skin staples instead of original technique of mesh fixation with sutures in Lichtenstein's hernioplasty. Few studies have been conducted, however, with inadequate follow-up and variable results. We have undertaken this study to compare the duration of surgery and incidence of recurrence (beyond 1 year) and chronic pain after mesh fixation with staples versus sutures. In this retrospective cohort study, adult males with primary unilateral inguinal hernia who underwent open Lichtenstein's hernioplasty from January 2009 till October 2010 were included. All patients with recurrent hernia, concomitant surgery, follow-up less than 1 year and missing data were excluded. Data collection was done via questionnaire and telephonic interviews. Outcomes are recurrence, chronic pain and duration of surgery. We reviewed 70 patients in each group. At median follow-up of 21 months (range 12-34), there was 0 % recurrence in both the groups and chronic pain was 4.4 % higher in suture versus staple group (11.4 vs. 7 %, p value = 0.7). Median duration of surgery was 30 min higher in suture as compared to staple group (90 vs. 60 min, p value = 0.004). Our study confirms that staples are superior to the sutures due to shorter operative time and do not cause any additive risk of recurrence or chronic pain. Prospective trial with long-term follow-up for each patient is required to validate these findings in order to generate definite guidelines.

Retrospective Review of Wound Complications Following Skin Closure by Either Percutaneous Metal Staples or Absorbable Subcuticular Staples in Patients Undergoing Cesarean Delivery

Objective: To determine the wound complication rate of patients undergoing cesarean delivery skin closure by either percutaneous metal staples or absorbable subcuticular staples in a large teaching hospital. Methods: This was a retrospective chart review of six hundred sixty patients who underwent cesarean delivery skin closure with either metal staples or absorbable staples. The primary outcome examined was the development of any wound complications. Results: Two hundred forty eight patients were eligible for analysis in the metal staple group compared to sixty-five patients in the absorbable staple group. A 7.7% wound complication rate was observed in the absorbable staple group compared to a 21.3% wound complication rate in the metal staple group. A statistical difference (p=0.01) was noted between the two groups. Body mass index between both groups were also statically different yielding 37 kg/m2 in the metal staple arm group versus 32 kg/m2 (p ≤ 0.001) in the absorbable staple group. Conclusion: Percutaneous metal staples were associated with more wound complications compared to absorbable subcuticular staples. Body mass index was greater in the percutaneous metal staple group as compared to the absorbable subcuticular staple group.

Sutures versus staples for wound closure in orthopaedic surgery: a pilot randomized controlled trial

BackgroundIn the spectrum of surgical decision-making, wound closure material is often an afterthought. However, the findings of a recent meta-analysis suggest that the rate of surgical site infections (SSIs) is increased by using staples to close surgical wounds. Less clear is the effect of closure material on the incidence of non-infectious wound complications.The aim of this study was to compare sutures and staples in terms of: incidence of wound complications to determine the sample size for a definitive trial comparing wound closure methods.MethodsEligible adult orthopaedic patients were randomized to have wounds closed with sutures or staples. Time for skin closure was recorded. Wounds were assessed for complications for six weeks. The incidence of complications was compared using Fisher’s exact test. Time to close and pain with removal of closure material were compared using a Student’s t-test.ResultsThe total number of patients reporting a wound complication was 59 of 148 patients completing six-week followup (41%), with no differennce between sutures and staples (RR = 0.77, CI = 0.52–1.14). The time to close wounds was shorter in the staple group (mean=4.8 min, CI = 2.6–7.1) than the suture group (mean=12 min, CI = 7.9–16). Patients in the staple group (mean=3.7, CI =2.8–4.6) reported more pain with removal than suture group (mean=2.5, CI =1.6–3.4).ConclusionsThis study suggests that 42% of patients report a wound complication with no difference between sutures and staples. It was demonstrated that suturing skin requires more time and staples are more painful to remove.Trial registrationClinicaltrials.gov identifier NCT01146236 (registered June 14, 2010)

Total Hip Arthroplasty and Surgical Wound Closure: Sutures Versus Staples

Discrepancies exist between studies that compare sutures and staples. We retrospectively reviewed 142 consecutive cases of total hip arthroplasty that had surgical wound re-approximation by either staples or absorbable subcuticular sutures. To our knowledge, this is the largest analysis of its kind in the literature. There were equal numbers of cases of sutures and staples (n=71). Two (2.8%) patients in the staple group developed an infection (one superficial and one organ/space) and 1 (1.4%) patient in the suture group developed a superficial infection. The mean total surgical time for the suture group was 119.6 minutes (sd=39.0) and 115.3 minutes (sd=24.2) for the staple group. No significant association was found between closure type and complications or surgical time (p>0.05 for all).