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Kouzu K, Kabata D, Shinkawa H, Shinji S, Ishinuki T, Tamura K, Uchino M, Ohge H, Shimizu J, Haji S, Mohri Y, Yamashita C, Kitagawa Y, Suzuki K, Kobayashi M, Kobayashi M, Hanai Y, Nobuhara H, Imaoka H, Yoshida M, Mizuguchi T, Mayumi T, Kitagawa Y. Association between skin suture devices and incidence of incisional surgical site infection after gastrointestinal surgery: systematic review and network meta-analysis. J Hosp Infect 2024; 150:134-144. [PMID: 38901769 DOI: 10.1016/j.jhin.2024.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/05/2024] [Accepted: 04/06/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Surgical site infections (SSIs) are common complications after abdominal surgery. AIM To compare which suture devices could reduce the incidence of incisional surgical site infections (SSIs) after gastrointestinal surgery using a systematic review and network meta-analysis. METHODS The CENTRAL, PubMed, and ICHUSHI-Web databases were searched from January 1st, 2000, to December 31st, 2022, for randomized clinical trials (RCTs) comparing the incidence of incisional SSI after gastrointestinal surgery among patients treated with different surgical suture devices, including non-absorbable sutures, absorbable sutures, skin staplers, and tissue adhesives (last searched in August 23th, 2023). The risk of bias was assessed using the criteria of the Cochrane Handbook for Systematic Reviews of Interventions. To estimate the pooled odds ratios (ORs) for each comparison, a fixed-effect inverse-variance model based on the Mantel-Haenszel approach was employed. FINDINGS A total of 18 RCTs with 5496 patients were included in this study. The overall SSIs in absorbable sutures were significantly lower than those in skin staplers (OR: 0.77; 95% confidence intervals (CI): 0.63-0.95) and non-absorbable sutures (OR: 0.62; 95% CI: 0.39-0.99), whereas SSIs in absorbable sutures were not significantly different from the SSIs in tissue adhesive. The highest P-score was 0.91 for absorbable sutures. A funnel plot for estimating the heterogeneity of the studies revealed that a publication bias would be minimal (Egger test, P = 0.271). CONCLUSION This study showed that absorbable sutures reduced incisional SSIs in gastrointestinal surgical operations compared to any other suture devices.
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Affiliation(s)
- K Kouzu
- Department of Surgery, National Defence Medical College, Saitama, Japan.
| | - D Kabata
- Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - H Shinkawa
- Department of Hepatobiliary-Pancreatic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - S Shinji
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - T Ishinuki
- Department of Nursing, Division of Surgical Science, Sapporo Medical University, Hokkaido, Japan
| | - K Tamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - M Uchino
- Department of Gastroenterological Surgery, Division of Inflammatory Bowel Disease, Hyogo Medical University, Hyogo, Japan
| | - H Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan
| | - J Shimizu
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - S Haji
- Department of Surgery, Soseikai General Hospital, Kyoto, Japan
| | - Y Mohri
- Department of Surgery, Mie Prefectural General Medical Center, Mie, Japan
| | - C Yamashita
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Aichi, Japan
| | - Y Kitagawa
- Department of Infection Control, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - K Suzuki
- Department of Infectious Disease Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - M Kobayashi
- Department of Anesthesiology, Hokushinkai Megumino Hospital, Hokkaido, Japan
| | - M Kobayashi
- Laboratory of Clinical Pharmacokinetics, School of Pharmacy, Kitasato University, Tokyo, Japan
| | - Y Hanai
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Tokyo, Japan
| | - H Nobuhara
- Department of Dentistry, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - H Imaoka
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - M Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | - T Mizuguchi
- Department of Nursing, Division of Surgical Science, Sapporo Medical University, Hokkaido, Japan
| | - T Mayumi
- Department of Intensive Care Unit, Japan Community Healthcare Organization Chukyo Hospital, Aichi, Japan
| | - Y Kitagawa
- Keio University, School of Medicine, Tokyo, Japan
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Fukai S, Mizusawa Y, Noda H, Tsujinaka S, Maeda Y, Hasebe R, Eguchi Y, Kanemitsu R, Matsuzawa N, Abe I, Endo Y, Fukui T, Takayama Y, Ichida K, Inoue K, Muto Y, Watanabe F, Futsuhara K, Miyakura Y, Rikiyama T. Superiority trial for the development of an ideal method for the closure of midline abdominal wall incisions to reduce the incidence of wound complications after elective gastroenterological surgery: study protocol for a randomized controlled trial. Trials 2024; 25:327. [PMID: 38760769 PMCID: PMC11100179 DOI: 10.1186/s13063-024-08167-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 05/09/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND The recent guidelines from the European and American Hernia Societies recommend a continuous small-bite suturing technique with slowly absorbable sutures for fascial closure of midline abdominal wall incisions to reduce the incidence of wound complications, especially for incisional hernia. However, this is based on low-certainty evidence. We could not find any recommendations for skin closure. The wound closure technique is an important determinant of the risk of wound complications, and a comprehensive approach to prevent wound complications should be developed. METHODS We propose a single-institute, prospective, randomized, blinded-endpoint trial to assess the superiority of the combination of continuous suturing of the fascia without peritoneal closure and continuous suturing of the subcuticular tissue (study group) over that of interrupted suturing of the fascia together with the peritoneum and interrupted suturing of the subcuticular tissue (control group) for reducing the incidence of midline abdominal wall incision wound complications after elective gastroenterological surgery with a clean-contaminated wound. Permuted-block randomization with an allocation ratio of 1:1 and blocking will be used. We hypothesize that the study group will show a 50% reduction in the incidence of wound complications. The target number of cases is set at 284. The primary outcome is the incidence of wound complications, including incisional surgical site infection, hemorrhage, seroma, wound dehiscence within 30 days after surgery, and incisional hernia at approximately 1 year after surgery. DISCUSSION This trial will provide initial evidence on the ideal combination of fascial and skin closure for midline abdominal wall incision to reduce the incidence of overall postoperative wound complications after gastroenterological surgery with a clean-contaminated wound. This trial is expected to generate high-quality evidence that supports the current guidelines for the closure of abdominal wall incisions from the European and American Hernia Societies and to contribute to their next updates. TRIAL REGISTRATION UMIN-CTR UMIN000048442. Registered on 1 August 2022. https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000055205.
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Affiliation(s)
- Shota Fukai
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yuki Mizusawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Hiroshi Noda
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan.
| | - Shingo Tsujinaka
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yukihisa Maeda
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Ryuji Hasebe
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yusuke Eguchi
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Rina Kanemitsu
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Natsumi Matsuzawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Iku Abe
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yuhei Endo
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Taro Fukui
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yuji Takayama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Kosuke Ichida
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Koetsu Inoue
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yuta Muto
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Fumiaki Watanabe
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Kazushige Futsuhara
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Yasuyuki Miyakura
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
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Aguirre-Allende I, Alkorta-Zuloaga M, Iglesias-Gaspar MT, Urreta-Ballobre I, García-Domínguez A, Arteaga-Martin X, Beguiristain-Gómez A, Medrano-Gómez MÁ, Ruiz-Montesinos I, Riverola-Aso AP, Jiménez-Agüero R, Enríquez-Navascués JM. Subcuticular suture and incisional surgical-site infection in elective hepatobiliary and pancreatic surgery: an open-label, pragmatic randomized clinical trial (CLOSKIN trial). BMC Surg 2023; 23:9. [PMID: 36639756 PMCID: PMC9837932 DOI: 10.1186/s12893-023-01911-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Subcuticular suture has proven to reduce superficial incisional SSI (si-SSI) in clean surgery. However, question remains regarding clean-contaminated procedures. The aim of this study is to assess if subcuticular suture is superior to staples in reducing si-SSI incidence in elective HBP surgery. METHODS Single-centre, open-label, parallel, pragmatic randomized clinical trial conducted at a referral tertiary Hospital between January 2020 and April 2022. Patients eligible for elective HBP surgery were randomly assigned (1:1) to subcuticular suture or surgical staples wound closure using a minimisation method based on previously confirmed risk factors. The primary endpoint was the incidence of si-SSI. Considered secondary endpoints were major postoperative morbidity in both groups, additional wound complications, median hospital length of stay and need for re-hospitalisation. RESULTS Of the 379 patients, 346 patients were randomly assigned to receive skin closure with staples (n = 173) or subcuticular suture (n = 173). After further exclusion of 11 participants, 167 and 168 patients, respectively in the control and the experimental group received their allocated intervention. For the primary endpoint, no significant differences in si-SSI rate were found: 17 (9.82%) staples group vs. 8 (4.62%) in subcuticular suture group (p = 0.062). Subset analysis confirmed absence of significant differences. As for secondary endpoints, overall wound complications did not differ significantly between two procedures: 19 (10.98%) vs. 10 (6.35%) (p = 0.127). There were no treatment related adverse events. However, occurrence of si-SSI contributed to major postoperative morbidity in both groups (p < 0.001 and p = 0.018) and to a substantially prolonged postoperative hospitalization (p = 0.015). CONCLUSIONS Subcuticular suture might offer a relative benefit for skin closure reducing incidence of si-SSI after elective HBP surgery, although this was found not to be clinically relevant. Yet, this should not be interpreted as equivalence among both treatments. Therefore, wound closure strategy should not be based only on these grounds. TRIAL REGISTRATION NUMBER ISRCTN Registry number ISRCTN37315612 (registration date: 14/01/2020).
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Affiliation(s)
- Ignacio Aguirre-Allende
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Maialen Alkorta-Zuloaga
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Maria Teresa Iglesias-Gaspar
- grid.414651.30000 0000 9920 5292Clinical Epidemiology Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Iratxe Urreta-Ballobre
- grid.414651.30000 0000 9920 5292Clinical Epidemiology Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Amaia García-Domínguez
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Xabier Arteaga-Martin
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Adolfo Beguiristain-Gómez
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Miguel Ángel Medrano-Gómez
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Inmaculada Ruiz-Montesinos
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Ana Paula Riverola-Aso
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - Raúl Jiménez-Agüero
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Hepatobiliary and Pancreatic Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
| | - José María Enríquez-Navascués
- grid.414651.30000 0000 9920 5292General and Digestive Surgery Department, Colorectal Surgery Unit, Donostia University Hospital-IHO Donostialdea, IIS Biodonostia, Paseo Doctor Beguiristain S/N, 20014 Donostia-San Sebastian, Spain
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Kawaguchi C, Hokuto D, Yasuda S, Yoshikawa T, Kamitani N, Matsuo Y, Sho M. Advantages of skin closure with subcuticular suture for liver resection on postoperative and cosmetic outcomes: a propensity matched analysis. Langenbecks Arch Surg 2022; 407:1121-1129. [PMID: 34988640 DOI: 10.1007/s00423-021-02388-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/24/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The effects of subcuticular sutures on postoperative and cosmetic outcomes in patients who underwent liver resection have not been well studied. Here, we investigated the advantages of subcuticular suture compared to skin stapler regarding open liver resection. METHODS We assessed 342 patients who underwent liver resection at Nara Medical University between 2008 and 2015. They were divided into two groups: subcuticular suture and staple groups. Baseline characteristics and perioperative outcomes were retrospectively compared using one-to-one propensity score matching analysis. RESULTS In this period, 179 patients underwent skin closure with subcuticular sutures and 163 patients underwent skin closure with staples. After propensity matching, 85 pairs of cases were matched. The incidence of wound infection was similar in the two groups (3.5% in the subcuticular suture group and 9.4% in the staple group; p = 0.119). The length of hospital stay was significantly shorter in the subcuticular suture group than in the staple group (10 days vs 15 days; p < 0.001). In addition, the rate of patients who were discharged within 7 days after surgery was statistically higher in the subcuticular group (21.1% vs 3.5%, p = 0.001). Hypertrophic scar 6 months after surgery was significantly less frequent in the subcuticular group (9.4% vs 25.9%, p = 0.010). CONCLUSION Subcuticular sutures might be advantageous for liver surgery reducing length of hospital stay and proportion of hypertrophic scar.
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Affiliation(s)
- Chihiro Kawaguchi
- Department of Surgery, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara, 634-8522, Japan
| | - Daisuke Hokuto
- Department of Surgery, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara, 634-8522, Japan.
| | - Satoshi Yasuda
- Department of Surgery, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara, 634-8522, Japan
| | - Takahiro Yoshikawa
- Department of Surgery, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara, 634-8522, Japan
| | - Naoki Kamitani
- Department of Surgery, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara, 634-8522, Japan
| | - Yasuko Matsuo
- Department of Surgery, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara, 634-8522, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University, 840 Shijo-cho Kashihara-shi, Nara, 634-8522, Japan
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Qin C, Li T, Zhao B, Wang Y, Li Z, Cao H, Zhou X, Yang X, Wang W. Subcuticular Sutures versus Staples in Reducing Surgical Site Infections after Open Abdominal Digestive Surgery: A System Review and Meta-Analysis of Randomized Controlled Trials. Surg Infect (Larchmt) 2021; 22:877-883. [PMID: 33989064 DOI: 10.1089/sur.2021.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Wound complications, primarily surgical site infections (SSIs), impose heavy a heavy burden on public health. This study aimed to compare the difference in the abilities of subcuticular sutures and staples to prevent SSIs after open abdominal surgery on the digestive system. Methods: A comprehensive search in Ovid-MEDLINE, Embase, Web of Science, and Cochrane Library (Central Register of Controlled Trials) was performed in January 2021. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PICOS (population, intervention, control, outcome, study type) model was applied to guide study selection and data extraction. Results: Six studies including 3,863 participants were included. According to analysis of SSI incidence, there was no obvious difference between the incidence of SSI when subcuticular sutures and staples were used (odds ratio [OR], 0.81; 95% confidence interval [CI], 0.61-1.08; p = 0.15). In the subsequent subgroup analysis of different operation procedures, the pooled results also failed to show significance for upper gastrointestinal surgery (OR, 1.09; 95% CI, 0.63-1.9; p = 0.75), lower gastrointestinal surgery (OR, 0.77; 95% CI, 0.56-1.05; p = 0.1), or hepatobiliary-pancreatic surgery (pooled OR, 0.72; 95% CI, 0.34-1.54; p = 0.4). Conclusions: Subcuticular sutures and staples did not show differences in their ability to prevent SSI incidence after open abdominal operation. These results require further verification by large-scale, high-quality randomized controlled trials.
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Affiliation(s)
- Cheng Qin
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Tianhao Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Bangbo Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuanyang Wang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zeru Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongtao Cao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xingtong Zhou
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoying Yang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Weibin Wang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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