Negative Pressure Wound Therapy for the Prevention of Wound Complications After Hepatopancreatobiliary Surgery: A Systematic Review and Meta-Analysis.

BACKGROUND AND AIMS: Hepatopancreatobiliary (HPB) surgeries, such as hepatic resection and pancreaticoduodenectomy, are associated with a high incidence of postoperative wound complications, particularly surgical site infections (SSIs). Negative pressure wound therapy (NPWT) has been proposed to reduce such complications, but its effectiveness in HPB surgery remains uncertain. This systematic review and meta-analysis aimed to evaluate the association between NPWT and postoperative wound complications following HPB procedures.

METHODS

We systematically searched PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus through August 17, 2024 for randomized controlled trials (RCTs) and observational studies comparing NPWT with standard surgical dressing (SSD) after HPB surgery. Primary outcomes were overall, superficial, deep, and organ-space SSIs. Secondary outcomes included seroma, hematoma, wound dehiscence, and hospital readmission. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model.

RESULTS

Eleven studies (7 RCTs, 4 observational; n = 1566) were included. Pooled analyses suggested that NPWT was associated with a lower risk of overall SSI compared with SSD (RR = 0.58, 95% CI = 0.45-0.75, p < 0.0001). When restricted to RCTs, the effect size was smaller and only approached statistical significance (RR = 0.70, p = 0.05). Superficial SSI (sSSI) rates were lower in the NPWT group, although this finding was not maintained in sensitivity analyses. No significant differences in deep or organ-space infections, or other secondary outcomes. Subgroup analyses suggested a greater potential benefit in pancreatectomy cases (RR = 0.61, p = 0.001). PICO devices were associated with reduced SSI risk, whereas PREVENA systems showed no statistically significant association.

CONCLUSIONS

NPWT may reduce postoperative SSIs following HPB surgeries, particularly in patients undergoing pancreatectomy. However, the observed benefit was less robust in RCT-only analyses, and evidence for liver surgery remains limited. Further high-quality RCTs are needed to validate these findings.