Skin stapler versus subcuticular suture for port-site skin closure in patients undergoing laparoscopic sleeve gastrectomy – A registry-based retrospective study over 4 years

INTRODUCTION: Port-site closure during laparoscopic sleeve gastrectomy (LSG) presents unique challenges owing to obesity, which can complicate wound healing and elevate the risk of wound-related complications. The aim of this study is to compare skin closure outcomes, utilising subcuticular sutures versus staples in morbidly obese patients undergoing LSG. PATIENTS AND METHODS: This was a retrospective research performed on 1655 cases retrieved from Al-Emies Bariatric Center registry database, recording all cases having LSG between 1 January 2021 and 31 December 2024. Patients were divided based on the skin closure technique into stapler group (n = 1034) and suture group (n = 621). The primary endpoint was the rate of superficial surgical site infection (SSI) within 30 days postoperatively. RESULTS: The skin suture group demonstrated a significant increase in both skin closure time (seconds) and time to healing (days) compared to the skin stapler group. Superficial SSI was significantly more encountered in the skin suture group, compared to the stapler group (3.54 vs. 0.77%, P < 0.001). Patients in the stapler group had 79% lower odds of superficial infection, contrasted with odds in the suture group (odds ratio [OR] =0.21; 95% confidence interval [CI] [0.09-0.48]). No significant difference was reported amongst the groups, considering deep infection or wound dehiscence. CONCLUSION: Skin closure by staples is advantageous over sutures in morbidly obese cases undergoing LSG, being associated with shorter surgery duration, shorter time to healing and lower odds of wound infection, seroma and haematoma. There were no significant long-term differences in the scar cosmetic quality.