Negative Pressure Wound Therapy for Emergency Laparotomy: A Meta-Analysis With Trial Sequential Analysis
In brief
Negative-pressure dressings nearly halve infections after emergency laparotomy, but evidence is uncertain
Across eight trials involving 1,348 patients, negative-pressure wound therapy was linked to about half the risk of surgical site infection compared with standard dressings. But results varied, the largest trial found no benefit, and small-study effects weaken confidence; therapy was also linked to fewer seromas and wound separations, with no shorter hospital stay. The evidence supports selective, not routine, use.
- Journal
- The Journal of surgical research (Q1)
- Published
- 30 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Abdullah M Alharran, Sarah Saqer Alblooshi, Sarah M Sabzali, Yousiff A Bahman, Hamza A Abdul-Hafez, Fajer Hasan, et al.
- PMID
- 42962611
- DOI
- 10.1016/j.jss.2026.09.020
Why clinicians should know about it
- Picked for Surgery (paper of the day, 2 November 2026): Randomized-trial meta-analysis of wound therapy after emergency laparotomy
Abstract
INTRODUCTION: Surgical site infection (SSI) remains a frequent and clinically important complication after emergency laparotomy. Closed-incision negative pressure wound therapy (NPWT) has been proposed to reduce wound-related complications, but evidence in emergency laparotomy remains mixed. METHODS: Databases were searched from inception to January 2026. Randomized controlled trials comparing NPWT with standard dressings after emergency laparotomy were included. The primary outcome was SSI. Secondary outcomes were seroma, wound dehiscence, and length of hospital stay (LOS). Random-effects meta-analyses were performed using risk ratios (RRs) or mean differences with 95% confidence intervals (CIs). Trial sequential analysis was used to assess the robustness of cumulative evidence. Certainty of evidence was assessed using Grading of Recommendations Assessment Development and Evaluation. RESULTS: Eight randomized controlled trials were included. The pooled SSI estimate favored NPWT (8 studies, n = 1348; RR, 0.46; 95% confidence interval (CI), 0.28 to 0.76; P = 0.0021), but heterogeneity was substantial (I2 = 71.1%), the largest trial was neutral, and marked asymmetry suggested substantial small study effects. NPWT was also associated with significantly lower risks of seroma (4 studies, n = 1057; RR, 0.60; 95% CI, 0.38 to 0.93; P = 0.0232; I2 = 0.0%) and wound dehiscence (7 studies, n = 1287; RR, 0.59; 95% CI, 0.37 to 0.93; P = 0.0238; I2 = 32.8%). No significant difference was observed for LOS (7 studies, n = 1287). Certainty of evidence was low for SSI and LOS, and moderate for seroma and wound dehiscence. CONCLUSIONS: In emergency laparotomy, prophylactic NPWT showed a directionally favorable but uncertain SSI signal and was associated with lower risks of seroma and wound dehiscence, but not shorter hospital stay. The SSI estimate should be interpreted cautiously because of substantial heterogeneity, marked small study effects, and the neutral result of the largest trial. These findings support a selective rather than routine use of NPWT.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.