Efficacy and safety of mesh closure in preventing wound failure following emergency laparotomy: a systematic review and meta-analysis

Albendary, Mohamed; Mohamedahmed, Ali Yasen Y.; Alamin, Amin; Rout, Shantanu; George, Anil Thomas; Zaman, Shafquat

doi:10.1007/s00423-021-02421-4

Cited by 7 publications

(4 citation statements)

References 54 publications

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“…Data highlight a significant reduction in the incisional hernia rate in elective settings, and trends suggest a significantly lower rate of incisional hernia in emergency laparotomies [ 13 , 15 , 103 ]. Prophylactic mesh augmentation after midline incision significantly impacts incisional hernia and does not predict an increased risk of postoperative complications [ 104 – 115 ]. However, a systematic review on the use of mesh in emergency surgery included only two small RCTs.…”

Section: Resultsmentioning

confidence: 99%

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ECLAPTE: Effective Closure of LAParoTomy in Emergency—2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings

et al. 2023

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Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking. This paper aims to present the World Society of Emergency Surgery (WSES) project called ECLAPTE (Effective Closure of LAParoTomy in Emergency): the final manuscript includes guidelines on the closure of emergency laparotomy.

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Section: Resultsmentioning

confidence: 99%

“…However, a systematic review on the use of mesh in emergency surgery included only two small RCTs. The evidence does not suggest that the wound failure is lower in the mesh group [ 104 ]. Other observational studies are likely biased, and data must be regarded carefully, specifically about SSI rates.…”

Section: Resultsmentioning

confidence: 99%

ECLAPTE: Effective Closure of LAParoTomy in Emergency—2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings

et al. 2023

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“…The choice of suture technique and material for abdominal wall closure is crucial for preventing fascia dehiscence and represents the primary factor under the surgeon's control. Despite this, a recent cross-sectional study among surgeons participating in a large multicenter trial has highlighted a lack of consensus on the optimal strategies for abdominal wall closure, especially in the context of emergency laparotomies (3). Laparotomies are frequently performed procedures within surgical departments, and surgical wound dehiscence following laparotomy is a grave complication.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Continuous versus Interrupted Closure of Midline Wound in Emergency Laparotomies in Terms of Wound Dehiscence

Khan,

Jaffer,

Ullah

et al. 2024

JHRR

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Background: Midline laparotomy is widely recognized as the preferred technique for abdominal surgeries due to its simplicity and the effective exposure it provides. Despite its prevalence, the optimal method for closing the incision remains a topic of debate among surgeons, particularly when balancing the risk of wound dehiscence with the practicalities of surgical practice. The mechanical properties of suture materials and techniques, such as continuous versus interrupted suturing, directly influence wound integrity during the critical postoperative period. Objective: The aim of this study was to compare the effectiveness and complication rates of continuous versus interrupted suturing techniques in midline laparotomies, with a focus on the incidence of wound dehiscence. Methods: This randomized controlled trial included 180 patients undergoing emergency laparotomy, divided into two groups: continuous closure (Group A) and interrupted closure (Group B). The study was conducted at Lady Reading Hospital MTI, Peshawar, with ethical committee approval. Participants were informed, consented, and demographic data were recorded. Suture techniques were performed by an experienced surgeon, and patients were monitored for wound dehiscence up to the 15th postoperative day. Data were analyzed using SPSS version 25. Results: Group A reported a wound dehiscence rate of 14.4%, with an effectiveness rate of 85.6%. In comparison, Group B showed a significantly lower dehiscence rate of 5.6% and an effectiveness rate of 94.4%. The age-wise distribution of effectiveness indicated no statistically significant difference between the groups across various age ranges, with P-values ranging from 0.2766 to 0.6037. Gender-wise, males and females also did not show significant differences in effectiveness between the two groups. Conclusion: Interrupted suturing for midline laparotomy closures showed a lower incidence of wound dehiscence compared to continuous suturing. However, factors such as increased surgery time and cost, along with postoperative issues like stitch sinus formation, need consideration. Further large-scale studies are recommended to evaluate the long-term outcomes and provide a more comprehensive assessment of the two techniques.

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“…[5][6][7][8][9] However, objective evidence for its routine use, as synthesized by two recent meta-analyses, is limited. 10,11 Additionally, data are not available for the outcomes of PMP in patients undergoing EML for intestinal perforation peritonitis, prompting us to conduct this prospective observational study to assess its safety and efficacy in these cases.…”

Section: Introductionmentioning

confidence: 99%

Prophylactic mesh placement in emergency midline laparotomy for intestinal perforation peritonitis: An appeal for caution

et al. 2022

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Prophylactic mesh placement (PMP) is increasingly being used to reduce the incidence of incisional hernia after routine and emergency midline laparotomy (EML). However, such studies are not available for EMLs done solely for intestinal perforation. Patients who underwent non-absorbable PMP during EML for intestinal perforation (Group A, 15 patients) were compared with those who had a conventional abdominal wall closure (Group B, 20 patients). The incidence of wound dehiscence was significantly higher in Group A, while surgical site infection (SSI), and incisional hernia were similar in both groups. Mesh explantation was needed in half the cases. A prophylactically placed non-absorbable mesh in patients undergoing EML for intestinal perforation is associated with significantly higher rates of wound dehiscence and of mesh explantation and therefore, routine use of such a mesh appears not to be justified.

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Efficacy and safety of mesh closure in preventing wound failure following emergency laparotomy: a systematic review and meta-analysis

Cited by 7 publications

References 54 publications

ECLAPTE: Effective Closure of LAParoTomy in Emergency—2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings

ECLAPTE: Effective Closure of LAParoTomy in Emergency—2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings

Effectiveness of Continuous versus Interrupted Closure of Midline Wound in Emergency Laparotomies in Terms of Wound Dehiscence

Prophylactic mesh placement in emergency midline laparotomy for intestinal perforation peritonitis: An appeal for caution

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