Department of Surgery, Zealand University Hospital, Koege, Denmark.
Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
World J Surg. 2018 Jun;42(6):1666-1678. doi: 10.1007/s00268-017-4393-9.
The aim of this systematic review and meta-analysis was to evaluate closure materials and suture techniques for emergency and elective laparotomies. The primary outcome was incisional hernia after 12 months, and the secondary outcomes were burst abdomen and surgical site infection.
A systematic literature search was conducted until September 2017. The quality of the RCTs was evaluated by at least 3 assessors using critical appraisal checklists. Meta-analyses were performed.
A total of 23 RCTs were included in the meta-analysis. There was no evidence from RCTs using the same suture technique in both study arms that any suture material (fast-absorbable/slowly absorbable/non-absorbable) is superior in reducing incisional hernias. There is no evidence that continuous suturing is superior in reducing incisional hernias compared to interrupted suturing. When using a slowly absorbable suture for continuous suturing in elective midline closure, the small bites technique results in significantly less incisional hernias than a large bites technique (OR 0.41; 95% CI 0.19, 0.86).
There is no high-quality evidence available concerning the best suture material or technique to reduce incisional hernia rate when closing a laparotomy. When using a slowly absorbable suture and a continuous suturing technique with small tissue bites, the incisional hernia rate is significantly reduced compared with a large bites technique.
本系统评价和荟萃分析旨在评估紧急和择期剖腹术的闭合材料和缝合技术。主要结局为 12 个月后的切口疝，次要结局为腹部破裂和手术部位感染。
系统检索文献直至 2017 年 9 月。至少有 3 名评估员使用批判性评估清单评估 RCT 的质量。进行荟萃分析。
共有 23 项 RCT 纳入荟萃分析。没有证据表明在研究臂中使用相同缝合技术的 RCT 中，任何缝合材料（可吸收快/可吸收慢/不可吸收）在减少切口疝方面更具优势。没有证据表明连续缝合比间断缝合在减少切口疝方面更具优势。在使用可吸收慢的缝线进行择期中线闭合的连续缝合时，小切口技术导致的切口疝明显少于大切口技术（OR 0.41；95%CI 0.19，0.86）。
关于减少剖腹术后切口疝发生率的最佳缝合材料或技术，尚无高质量证据。在使用可吸收慢的缝线和小组织咬口的连续缝合技术时，与大咬口技术相比，切口疝发生率显著降低。
