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01-12-2023 | Wound Dehiscence | Systematic Review

Abdominal wound dehiscence and incisional hernia prevention in midline laparotomy: a systematic review and network meta-analysis

Authors: Edgard Efrén Lozada Hernández, Juan Pablo Hernández Bonilla, Diego Hinojosa Ugarte, Miguel Magdaleno García, Juan Carlos Mayagoitía González, Luis Abraham Zúñiga Vázquez, Enrique Obregón Moreno, Aldo Edyair Jiménez Herevia, Roland Kevin Cethorth Fonseca, Paulina Ramírez Guerrero

Published in: Langenbeck's Archives of Surgery | Issue 1/2023

Abstract

Background

Incisional hernia (IH) is the main complication after laparotomy. In an attempt to reduce this complication, mesh techniques and studies in which the closure technique is modified have been proposed. Both types are characterized by comparison with the closure described as standard or conventional: 1 × 1, mass, and continuous closure. For this study, modified closure techniques (MCTs) were considered as those techniques in which an extra suture is placed (reinforced tension line (RTL), retention), the closure point is modified in distance (small bites) or shape (CLDC, Smead Jones, interrupted, Cardiff point) and which aim to reduce these complications. The objective of this network meta-analysis (NMA) was to evaluate the effectiveness of MCTs for reducing the incidence of IH and abdominal wound dehiscence (AWD) to provide objective support for their recommendation.

Methods

An NMA was performed according to the PRISMA-NMA guidelines. The primary objective was to determine the incidence of IH and AWD, and the secondary objective was to determine the incidence of postoperative complications. Only published clinical trials were included. The risk of bias was analyzed, and the random-effects model was used to determine statistical significance.

Results

Twelve studies comparing 3540 patients were included. The incidence of HI was lower in RTL, retention suture, and small bites, these techniques showed statistical differences with pooled ORs (95% CI) of 0.28 (0.09–0.83), 0.28 (0.13–0.62), and 0.44 (0.31–0.62), respectively. Associated complications, including hematoma, seroma, and postoperative pain, could not be analyzed; however, MCTs did not increase the risk of surgical site infection.

Conclusion

Small bites, RTL, and retention sutures decreased the prevalence of IH. RTL and retention suture decreased the prevalence of AWD. RTL was the best technique as it reduced both complications (IH and AWD) and had the best SUCRA and P-scores, and the number needed to treat (NNT) for net effect was 3.

Registration

This study was prospectively registered in the PROSPERO database under registration number CRD42021231107.

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Title: Abdominal wound dehiscence and incisional hernia prevention in midline laparotomy: a systematic review and network meta-analysis
Authors: Edgard Efrén Lozada Hernández
Juan Pablo Hernández Bonilla
Diego Hinojosa Ugarte
Miguel Magdaleno García
Juan Carlos Mayagoitía González
Luis Abraham Zúñiga Vázquez
Enrique Obregón Moreno
Aldo Edyair Jiménez Herevia
Roland Kevin Cethorth Fonseca
Paulina Ramírez Guerrero
Publication date: 01-12-2023
Publisher: Springer Berlin Heidelberg
Keywords: Wound Dehiscence
Laparotomy
Laparotomy
Incisional Hernia
Published in: Langenbeck's Archives of Surgery / Issue 1/2023
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-023-02954-w

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Abdominal wound dehiscence and incisional hernia prevention in midline laparotomy: a systematic review and network meta-analysis

Abstract

Background

Methods

Results

Conclusion

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Keynote webinar | Spotlight on medication adherence

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Abstract

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Results

Conclusion

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