Comparison of absorbable uterine staples and traditional hysterotomy during cesarean delivery

OBJECTIVE: To evaluate the use of the Auto Suture Poly CS-57 disposable surgical stapler to determine if the device offers any advantages over suture closure of the uterus. METHODS: A matched case-control study design was used. Operative time, estimated blood loss, change in hematocrit, incidence of postoperative endometritis, length of stay, and total patient costs were compared. Patients were recruited from a university hospital setting and a private practice. RESULTS: There were 288 patients in the study, 144 in the staple group and 144 matched patients in the standard hysterotomy control group. Patients did not differ in age, parity, gestational age, number of primary or repeat operations, anesthesia, infant weights, or outcomes. Comparing the patients in the staple group and the control group, there was no significant difference in operative time (63.7 +/- 22.9 versus 62.0 +/- 22.3 minutes, staple group versus controls, respectively), estimated blood loss (822 +/- 338 versus 879 +/- 318 mL), change in hematocrit (-5.9 versus -6.5 volume percent), incidence of postoperative endometritis (15 versus 20%), length of stay (4.1 +/-1.3 versus 4.0 +/- 2.2 days), or total cost ($4490 +/- 1544 versus $3997 +/- 1117). Comparing patients operated upon by residents in the university to those operated upon by the private attending physicians, there were no significant differences noted in the above-mentioned variables between stapled and sutured patients. CONCLUSION: Compared with the usual suture technique for cesarean delivery, the uterine stapling device used in this study was not associated with a significant decrease in the incidence of postoperative anemia, infection, length of hospital stay, or cost. This device appears to offer no advantage over traditional hysterotomy and repair.