Date of Award


Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant


Physician Assistant Studies

Department Chair

John Cavenagh, PhD, PA-C


OBJECTIVE:The objective of this selective EBM review is to determine whether or not there is a benefit to suturing vs stapling in cesarean section closure when comparing postoperative pain and patient satisfaction.

STUDY DESIGN: Review of three English language primary studies published in 2009 and 2010.

DATA SOURCES: Three randomized control trials (RCTs) comparing the surgical closures for cesarean section delivery. All RCTs were found by the author using MEDLINE, PUBMED, and COCHRANE databases. They are all published articles written in English.

OUTCOME MEASURED: Outcomes were measured by assessing patient satisfaction, postoperative pain, cosmetic appearance and wound complications. Rousseau et al used the analog pain scale to assess postoperative pain. In this study a photograph was taken to evaluate the appearance of the incision, which was done by three independently blinded physician observers. Basha et al used telephone interviews to follow-up on patient satisfaction and wound complication rates. During these interviews the Likert scale was used to assess patient satisfaction. Lastly, Cromi et al used objective (observer) components, the VSS and OSAS, and subjective (patient) components PSAS and VAS. These scales were used to examine the outcome of the postoperative scar and wound complications.

RESULTS: Basha et al determined that staples were associated with increased risk of wound infection. Wound complications led to a decrease in patient satisfaction, however it was not statistically significant to associate staples with decreased satisfaction. Rousseau et al found that postoperative pain was less in the staple group. Cromi et al and Rousseau et al both found there were equivalent cosmetic outcome amongst closure methods.
CONCLUSION: Postoperative pain and patient satisfaction with regards to each surgical closure remains inconclusive. While wound complications and wound dehiscence were more apparent in the use of staples, this had no bearing on overall patient satisfaction. Cosmetic appearance of the post-surgical scar was equivalent amongst both closure methods. A conclusion for the optimal method of cesarean closure is still one for future analysis.