Five trials were included in the review (877 women). All trials were reported to be moderate quality (Jadad scores 2 or 3 out of 5). Individually-scored criteria were not presented. Four trials included a power calculation. Follow-up ranged from two weeks to six months.
Wound complications were significantly more frequent in the group that received staples (OR 2.12, 95% CI 1.29 to 3.48; five trials). There was no evidence of statistical heterogeneity or publication bias. Removal of the largest trial with the highest complication rates showed no significant difference between the skin closure techniques.
Wound separation (dehiscence) was significantly more frequent in the group that received staples (OR 4.07, 95% CI 2.07 to 8.00; four trials). There was no evidence of statistical heterogeneity or publication bias. Removal of the largest trial continued to demonstrate a much higher separation rate in the group that received staples but statistical significance was lost.
Staple closure significantly reduced overall operating time (WMD -5.05 minutes, 95% CI -9.33 to -0.76; four trials; significant heterogeneity). Insufficient data were available to assess postoperative pain or patient satisfaction. Further analysis was reported in the paper.