Cochrane · systematic review · CD005661
Closure methods for laparotomy incisions for preventing incisional hernias and other wound complications
Patel, SV, Paskar, DD, Nelson, RL, et al. · Cochrane Database of Systematic Reviews · 2017 · Cochrane Library
ColorectalAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
20
current version
GRADE rated
20
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 4 · 20%Low 3 · 15%Moderate 13 · 65%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Absorbable versus non‐absorbable sutures for laparotomy incisions
Population: patients undergoing a laparotomy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Incisional hernia Absorbable vs non‐absorbable sutures | RR 1.07 [0.86, 1.32] | 17 studies · 4720 participants | Moderate Downgraded: risk of bias, imprecision |
Wound infection at last Absorbable vs non‐absorbable sutures | RR 0.99 [0.84, 1.17] | 29 studies · 8457 participants | Moderate Downgraded: risk of bias, imprecision |
Wound dehiscence at last Absorbable vs non‐absorbable sutures | RR 0.78 [0.55, 1.1] | 34 studies · 9004 participants | Moderate Downgraded: risk of bias, imprecision |
Sinus or fistula formation at last Absorbable vs non‐absorbable sutures | RR 0.49 [0.26, 0.94] | 19 studies · 5470 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Mass versus layered closure for laparotomy incisions
Population: patients undergoing laparotomy incisions
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Incisional hernia Mass vs layered closure | RR 1.92 [0.58, 6.35] | 5 studies · 1176 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Wound infection at last Mass vs layered closure | RR 0.93 [0.67, 1.3] | 11 studies · 2926 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Wound dehiscence at last Mass vs layered closure | RR 0.69 [0.31, 1.52] | 11 studies · 2863 participants | Moderate Downgraded: risk of bias, imprecision |
Sinus or fistula formation at last Mass vs layered closure | RR 0.49 [0.15, 1.62] | 6 studies · 1076 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Continuous versus interrupted closure for laparotomy incisions
Population: patients undergoing a laparotomy incision
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Incisional hernia Continuous vs interrupted closure | RR 1.01 [0.76, 1.35] | 11 studies · 3854 participants | Moderate Downgraded: risk of bias, imprecision |
Wound infection at last Continuous vs interrupted closure | RR 1.13 [0.96, 1.34] | 23 studies · 10039 participants | Moderate Downgraded: risk of bias, imprecision |
Wound dehiscence at last Continuous vs interrupted closure | RR 1.21 [0.9, 1.64] | 21 studies · 9228 participants | Moderate Downgraded: risk of bias, imprecision |
Sinus or fistula formation at last Continuous vs interrupted closure | RR 1.51 [0.64, 3.61] | 10 studies · 5082 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Monofilament versus multifilament sutures for laparotomy incisions
Population: patients undergoing a laparotomy incision
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Incisional hernia Monofilament vs multifilament sutures | RR 0.76 [0.59, 0.98] | 16 studies · 4520 participants | Moderate Downgraded: risk of bias, imprecision |
Wound infection at last Monofilament vs multifilament sutures | RR 1.08 [0.91, 1.28] | 23 studies · 6557 participants | Moderate Downgraded: risk of bias, imprecision |
Wound dehiscence at last Monofilament vs multifilament sutures | RR 1.24 [0.93, 1.67] | 22 studies · 6199 participants | Moderate Downgraded: risk of bias, imprecision |
Sinus or fistula formation at last Monofilament vs multifilament sutures | RR 1.91 [0.77, 4.73] | 8 studies · 2285 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Fast absorbable versus slow absorbable sutures for laparotomy incision
Population: patients undergoing a laparotomy incision
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Incisional hernia Fast absorbable vs slow absorbable sutures | RR 0.81 [0.63, 1.06] | 10 studies · 3643 participants | Moderate Downgraded: risk of bias, imprecision |
Wound infection at last Fast absorbable vs slow absorbable sutures | RR 1.16 [0.85, 1.57] | 11 studies · 4100 participants | Moderate Downgraded: risk of bias, imprecision |
Wound dehiscence at last Fast absorbable vs slow absorbable sutures | RR 1.55 [0.92, 2.61] | 8 studies · 3440 participants | Moderate Downgraded: risk of bias, imprecision |
Sinus or fistula formation at last Fast absorbable vs slow absorbable sutures | RR 0.88 [0.05, 16.05] | 2 studies · 911 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |