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Background: Varieties of methods are used to close the skin. Traditionally sutures (SS) have been used to close the skin but more recently metal staples (SC) were introduced with aim to reduce closure time and infection rates. Objective: We aim to assess the difference between clips and sutures in elective colorectal surgery in terms of wound infection, cosmetic result and overall patient satisfaction. Methods: Prospective case controlled cohort study including all the patients who underwent elective open colorectal surgery, data collection was achieved through anonymous patient questionnaires. Results: 218 filled questionnaires were received. 134 patients were allocated to SS group with median age of 67 (IQR 61, 74). SC group had a total of 84 patients with a median age of 69 (IQR 61, 71).15% of SS group developed wound infection, compared to 20% in SC group (p= 0.202).Over all 61% of SS group claimed excellent results compared to 46% in SC group (p=0.020). Conclusion: Our results showed that patients with non-absorbable sub-cuticular skin closure compared to clips had low infection rates, more satisfied with their scar and better cosmesis outcome. We therefore suggest using sub-cuticlar sutures to close the skin in abdominal elective open colorectal surgery. [ABSTRACT FROM AUTHOR]