Zucker B E, Simillis C, Tekkis P, Kontovounisios C
Department of Colorectal Surgery, Chelsea and Westminster Hospital , London , UK.
Department of Colorectal Surgery, Royal Marsden Hospital , London , UK.
Ann R Coll Surg Engl. 2019 Mar;101(3):150-161. doi: 10.1308/rcsann.2018.0170. Epub 2018 Oct 5.
There are many options and little guiding evidence when choosing suture types with which to close the abdominal wall fascia. This network meta-analysis investigated the effect of suture materials on surgical site infection, hernia, wound dehiscence and sinus/fistula occurrence after abdominal surgery. The aim was to provide clarity on whether previous recommendations on suture choice could be followed with confidence.
In February 2017, the Cochrane Central Register of Controlled Trials, Medline, EMBASE and Science Citation Index Expanded were searched for randomised controlled trials investigating the effect of suture choice on these four complications in closing the abdomen. A reference search of identified trials was performed. Prisma guidelines and the Cochrane risk of bias tool were followed in the data extraction and synthesis. Two review authors screened titles and abstracts of trials identified. A random effect model was used for the surgical site infection network based on the deviance information criterion statistics.
Thirty-one trials were included (11,533 participants). No suture material reached the predetermined 90% probability threshold for determination of 'best treatment' for any outcome. Pairwise comparisons largely showed no differences between suture types for all outcomes measured. However, nylon demonstrated a reduction in the occurrence of incisional hernias with respect to two commonly used absorbable sutures: polyglycolic acid (odds ratio, OR 1.91; 95% confidence interval, CI, 1.01-3.63) and polyglyconate (OR 2.18; 95% CI 1.17-4.07).
No suture type can be considered the 'best treatment' for the prevention of surgical site infection, hernia, wound dehiscence and sinus/fistula occurrence.
在选择用于闭合腹壁筋膜的缝合线类型时，有多种选择但指导证据很少。这项网状Meta分析研究了缝合材料对腹部手术后手术部位感染、疝气、伤口裂开和窦道/瘘管发生的影响。目的是明确是否可以放心遵循先前关于缝合线选择的建议。
2017年2月，检索了Cochrane对照试验中央注册库、Medline、EMBASE和科学引文索引扩展版，以查找研究缝合线选择对腹部闭合中这四种并发症影响的随机对照试验。对已识别试验进行了参考文献检索。在数据提取和综合过程中遵循Prisma指南和Cochrane偏倚风险工具。两位综述作者筛选了已识别试验的标题和摘要。基于偏差信息准则统计，对手术部位感染网络使用随机效应模型。
纳入了31项试验（11533名参与者）。没有一种缝合材料在任何结局的“最佳治疗”判定中达到预定的90%概率阈值。成对比较在很大程度上显示，所测量的所有结局在缝合线类型之间没有差异。然而，与两种常用的可吸收缝合线相比，尼龙线在切口疝的发生率方面有所降低：聚乙醇酸（优势比，OR 1.91；95%置信区间，CI，1.01 - 3.63）和聚甘醇酸酯（OR 2.18；95% CI 1.17 - 4.07）。
没有一种缝合线类型可被视为预防手术部位感染、疝气、伤口裂开和窦道/瘘管发生的“最佳治疗”方法。
