Use of a zipline skin closure device in gastroenterological surgery: a multicenter randomized controlled trial assessing wound infection incidence, operation time, and cosmesis.

Subcuticular sutures, which are effective and cosmetically advantageous in gastroenterological surgery, are time-consuming and heavily dependent on the surgeon's technical expertise. This study aims to evaluate whether Zipline skin closure could be an alternative to subcuticular sutures in gastroenterological surgery. A multicenter randomized controlled trial (UMIN000048169) was conducted on 76 patients who underwent elective gastroenterological surgery. The patients were randomized to either the Zipline group (N = 35) or the subcuticular suture group (N = 41). Primary outcomes included skin closure time and secondary outcomes included postoperative wound complications and cosmetic results, assessed 6 months post-surgery, using the Stony Book Scar Evaluation Scale (SBSES). The Zipline group demonstrated significantly shorter closure times than the suture group (median: 438 s [406-526] vs. 575 s [537-638]; p = 0.003). This difference was more pronounced for incisions > 55 mm (median:399 s [307-533] vs. 605 s [493-736]; p = 0.001). No significant differences were observed in wound infection rates (5.7% vs. 2.4%; p = 0.46) or SBSES scores (median: 4.0 [4.0-5.0] vs. 4.0 [3.0-5.0; p = 0.82) between the two groups. The Zipline device reduced the skin closure time in gastroenterological surgery significantly, particularly for large incisions, without compromising wound healing or cosmetic outcomes. These findings suggest that the Zipline system may be a viable alternative to traditional subcuticular sutures in gastroenterological procedures, potentially promoting operating room efficiency without compromising surgical quality or patient outcomes.