Timmer Allard S, Wolfhagen Niels, Pianka Frank, Knebel Phillip, Justinger Christoph, Stravodimos Christos, Ichida Kosuke, Rikiyama Toshiki, Baracs József, Vereczkei András, Gianotti Luca, Sandini Marta, Ruiz-Tovar Jaime, Marc-Hernández Artur, Nakamura Toru, Dijkgraaf Marcel G W, Boermeester Marja A, de Jonge Stijn W
Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.
Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, Netherlands.
J Abdom Wall Surg. 2024 Sep 18;3:13337. doi: 10.3389/jaws.2024.13337. eCollection 2024.
Wound closure with triclosan-coated sutures (TCS) appears to reduce the risk of surgical site infection (SSI). Because there is a strong association between postoperative SSI and the development of acute abdominal wall dehiscence (AWD) after laparotomy, we hypothesized that the use of TCS for wound closure after laparotomy may also reduce the risk of AWD.
The MEDLINE, Embase, and CENTRAL databases were searched from their inception to 01 November 2022. Randomized trials that compared the use of TCS with identical but uncoated sutures for fascial closure were eligible if they could provide individual participant data (IPD) on AWD. From these trials, we only included in the analysis those subjects who underwent open abdominal surgery. The primary outcome was the incidence of AWD within 30 days postoperatively, requiring emergency reoperation. The certainty of evidence was assessed using the GRADE methodology (PROSPERO: CRD42019121173.
We identified twelve eligible trials. Eight studies shared IPD. The incidence of AWD within 30 days after surgery was 27/1,565 (1.7%) in the TCS group vs. 40/1,430 (2.8%) in the control group (Relative Risk: 0.70 [95% confidence interval (CI) 0.44-1.11, = 0%, τ = 0.00]). The certainty of evidence was moderate after downgrading for imprecision. The incidence of incisional SSI was 163/1,576 (10.3%) vs. 198/1,439 (13.8%), RR 0.80 (95% CI 0.67-0.97).
We found no conclusive evidence to support the use of triclosan-coated sutures for the prevention of acute abdominal wall dehiscence after laparotomy. In these selected studies, a significant reduction in incisional SSI was observed.
使用三氯生涂层缝线（TCS）进行伤口缝合似乎可降低手术部位感染（SSI）的风险。由于术后SSI与剖腹手术后急性腹壁裂开（AWD）的发生之间存在密切关联，我们推测剖腹手术后使用TCS进行伤口缝合也可能降低AWD的风险。
检索MEDLINE、Embase和CENTRAL数据库，检索时间从建库至2022年11月1日。比较使用TCS与相同但未涂层缝线进行筋膜缝合的随机试验，如果能够提供AWD的个体参与者数据（IPD）则符合纳入标准。从这些试验中，我们仅将接受开放性腹部手术的受试者纳入分析。主要结局是术后30天内需要急诊再次手术的AWD发生率。使用GRADE方法评估证据的确定性（PROSPERO：CRD42019121173）。
我们确定了12项符合条件的试验。8项研究共享了IPD。TCS组术后30天内AWD的发生率为27/1565（1.7%），对照组为40/1430（2.8%）（相对风险：0.70 [95%置信区间（CI）0.44 - 1.11，I² = 0%，τ = 0.00]）。因不精确性降级后，证据的确定性为中等。切口SSI的发生率为163/1576（10.3%） vs. 198/1439（13.8%），RR 0.80（95% CI 0.67 - 0.97）。
我们没有找到确凿证据支持使用三氯生涂层缝线预防剖腹手术后的急性腹壁裂开。在这些选定的研究中，观察到切口SSI有显著降低。
