Abdominal wound dehiscence and Incisional hernia prevention a systematic review and network meta-analysis of randomized clinical trials.
Background: Incisional hernia (IH) is the main complication after laparotomy. The objective of this network meta-analysis was to evaluate the effectiveness of closure technique modification (CTM) for reducing the incidence of IH and abdominal wound dehiscence (AWD) to provide objective support for its recommendation. Methods: A network meta-analysis was performed according to the PRISMA-NMA guidelines. The primary objective was to determine the incidence of IH and AWD 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 2,738 patients were included. The incidence of IH was significantly lower in the CTM group than in the control group, with an OR of 0.41 (95% CI 0.31-0.55). The incidence of AWD was also reduced, with an OR of 0.38 (95% CI 0.19-0.75). Associated complications, including hematoma, seroma, and postoperative pain, could not be analyzed; however, CTM did not increase the risk of surgical site infection. Conclusion: CTM for midline laparotomy significantly reduces the incidence of IH and AWD compared to conventional closure. Limitations of the analysis included differences in follow-up, patient selection, diagnostic methods, and the reporting of postoperative complications among the studies. Funding Information: No funding was received. Registration: This study was prospectively registered in the PROSPERO database under registration number CRD42021231107.