Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery · 2026
Effectiveness of negative pressure wound therapy versus conventional dressings in emergency laparotomy: a systematic review and meta-analysis of randomized controlled trials.
СтатьяСистематический обзорМетаанализСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Antonini Francielle de Souza, Paiva Maria Eduarda Caetano Batista de, Oliveira Filho Marcílio de, Nascimento Fabricio Inacio de Moraes, Massoud Rodrigo Ormanes, Pivetta Henrique Baggio, Fonseca Leticia Gatti, Costa José Victor Gomes, Zelenskaya Yekaterina, Akbari Zarpana, Duque Maria Isabel Lopez, Aguilar-Nascimento José Eduardo de, Pimenta Gunther Peres
Аннотация
BACKGROUND: Surgical site infections represent a significant complication after emergency laparotomy, contributing to increased morbidity, mortality, and healthcare costs. Negative pressure wound therapy (NPWT) may reduce the incidence of surgical site infections; however, evidence from randomized controlled trials remains inconsistent.
AIMS: To present a systematic review and meta-analysis, comparing NPWT with conventional dressings in emergency laparotomies.
METHODS: Systematic searches were conducted according to the Cochrane Handbook and reported according to the PRISMA 2020 guidelines. The PubMed, Embase, and Cochrane CENTRAL databases were searched since their inception, using terms related to emergency laparotomy, NPWT, and conventional dressings. The reference lists of included studies were manually examined to identify additional eligible trials. Only randomized controlled trials that compared NPWT with conventional dressings in emergency abdominal surgeries and that reported surgical site infection rates or other clinical outcomes were included. The primary outcome was the incidence of surgical site infection. Secondary outcomes included wound dehiscence, seroma formation, length of hospital stay, and 30-day mortality.
RESULTS: Eight randomized controlled trials, totaling 1,377 patients (707 in the NPWT group and 670 in the conventional dressing group), were included. NPWT significantly reduced the risk of surgical site infection (risk ratio [RR] 0.43; 95% confidence interval [CI] 0.26-0.73; p=0.002; heterogeneity [I2]=76%) and wound dehiscence (RR 0.32; 95%CI 0.18-0.58; p=0.0002). No significant differences were observed regarding seroma formation (RR 0.59; 95%CI 0.34-1.01; p=0.05), length of hospital stay (mean difference [MD] -0.39 days; 95%CI -1.15- 0.36; p=0.92) or mortality (RR 0.96; 95%CI 0.55-1.68; p=0.88).
CONCLUSIONS: This systematic review and meta-analysis of randomized clinical trials suggests that NPWT reduces the incidence of surgical site infection and wound dehiscence after emergency laparotomy, supporting its use in high-risk patients.
CENTRAL MESSAGE: Surgical site infections are a major postoperative complication after emergency laparotomies, contributing substantially to morbidity, mortality, and healthcare costs. Strategies to reduce postoperative complications have increasingly focused on perioperative optimization through evidence-based, multimodal protocols. Retrospective analyses have demonstrated the efficacy of intermittent negative pressure wound therapy in diminishing the incidence of surgical site infections following laparotomy in patients undergoing gynecological and general surgical procedures. Nonetheless, the findings derived from randomized controlled trials have yielded inconsistent results.
PERSPECTIVES: This original systematic review and meta-analysis of randomized controlled trials demonstrated the efficacy of negative pressure wound therapy in reducing the incidence of surgical site infections and wound dehiscence among patients undergoing emergency laparotomy when compared to conventional dressings.
AIMS: To present a systematic review and meta-analysis, comparing NPWT with conventional dressings in emergency laparotomies.
METHODS: Systematic searches were conducted according to the Cochrane Handbook and reported according to the PRISMA 2020 guidelines. The PubMed, Embase, and Cochrane CENTRAL databases were searched since their inception, using terms related to emergency laparotomy, NPWT, and conventional dressings. The reference lists of included studies were manually examined to identify additional eligible trials. Only randomized controlled trials that compared NPWT with conventional dressings in emergency abdominal surgeries and that reported surgical site infection rates or other clinical outcomes were included. The primary outcome was the incidence of surgical site infection. Secondary outcomes included wound dehiscence, seroma formation, length of hospital stay, and 30-day mortality.
RESULTS: Eight randomized controlled trials, totaling 1,377 patients (707 in the NPWT group and 670 in the conventional dressing group), were included. NPWT significantly reduced the risk of surgical site infection (risk ratio [RR] 0.43; 95% confidence interval [CI] 0.26-0.73; p=0.002; heterogeneity [I2]=76%) and wound dehiscence (RR 0.32; 95%CI 0.18-0.58; p=0.0002). No significant differences were observed regarding seroma formation (RR 0.59; 95%CI 0.34-1.01; p=0.05), length of hospital stay (mean difference [MD] -0.39 days; 95%CI -1.15- 0.36; p=0.92) or mortality (RR 0.96; 95%CI 0.55-1.68; p=0.88).
CONCLUSIONS: This systematic review and meta-analysis of randomized clinical trials suggests that NPWT reduces the incidence of surgical site infection and wound dehiscence after emergency laparotomy, supporting its use in high-risk patients.
CENTRAL MESSAGE: Surgical site infections are a major postoperative complication after emergency laparotomies, contributing substantially to morbidity, mortality, and healthcare costs. Strategies to reduce postoperative complications have increasingly focused on perioperative optimization through evidence-based, multimodal protocols. Retrospective analyses have demonstrated the efficacy of intermittent negative pressure wound therapy in diminishing the incidence of surgical site infections following laparotomy in patients undergoing gynecological and general surgical procedures. Nonetheless, the findings derived from randomized controlled trials have yielded inconsistent results.
PERSPECTIVES: This original systematic review and meta-analysis of randomized controlled trials demonstrated the efficacy of negative pressure wound therapy in reducing the incidence of surgical site infections and wound dehiscence among patients undergoing emergency laparotomy when compared to conventional dressings.