Feier Catalin Vladut Ionut, Gaborean Vasile, Faur Ionut Flaviu, Vonica Razvan Constantin, Faur Alaviana Monique, Rus Vladut Iosif, Dragan Beniamin Sorin, Muntean Calin
Abdominal Surgery and Phlebology Research Center, Victor Babeș University of Medicine and Pharmacy, 300041 Timisoara, Romania.
First Surgery Clinic, "Pius Brinzeu" Clinical Emergency Hospital, 300723 Timişoara, Romania.
J Clin Med. 2025 Jul 22;14(15):5191. doi: 10.3390/jcm14155191.
: Postoperative pancreatic fistula and post-hepatectomy liver failure remain significant complications after HPB surgery; however, superficial surgical site infection (SSI) is the most frequent wound-related complication. Closed-incision negative-pressure wound therapy (ciNPWT) has been proposed to reduce superficial contamination, yet no liver-focused quantitative synthesis exists. We aimed to evaluate the effectiveness and safety of prophylactic ciNPWT after hepatopancreatobiliary (HPB) surgery. : MEDLINE, Embase, and PubMed were searched from inception to 30 April 2025. Randomized and comparative observational studies that compared ciNPWT with conventional dressings after elective liver transplantation, hepatectomy, pancreatoduodenectomy, and liver resections were eligible. Two reviewers independently screened, extracted data, and assessed risk of bias (RoB-2/ROBINS-I). A random-effects Mantel-Haenszel model generated pooled risk ratios (RRs) for superficial SSI; secondary outcomes were reported descriptively. : Twelve studies (seven RCTs, five cohorts) encompassing 15,212 patients (3561 ciNPWT; 11,651 control) met the inclusion criteria. Device application lasted three to seven days in all trials. The pooled analysis demonstrated a 29% relative reduction in superficial SSI with ciNPWT (RR 0.71, 95% CI 0.63-0.79; < 0.001) with negligible heterogeneity (I 0%). Absolute risk reduction ranged from 0% to 13%, correlating positively with the baseline control-group SSI rate. Deep/organ-space SSI (RR 0.93, 95% CI 0.79-1.09) and 90-day mortality (RR 0.94, 95% CI 0.69-1.28) were unaffected. Seven studies documented a 1- to 3-day shorter median length of stay; only two reached statistical significance. Device-related adverse events were rare (one seroma, no skin necrosis). : Prophylactic ciNPWT safely reduces superficial SSI after high-risk HPB surgery, with the greatest absolute benefit when baseline SSI risk exceeds ≈10%. Its influence on deep infection and mortality is negligible.
胰腺术后瘘和肝切除术后肝衰竭仍是肝胆胰（HPB）手术后的严重并发症；然而，浅表手术部位感染（SSI）是最常见的与伤口相关的并发症。已提出采用闭合切口负压伤口治疗（ciNPWT）来减少浅表污染，但目前尚无针对肝脏的定量综合分析。我们旨在评估肝胆胰（HPB）手术后预防性使用ciNPWT的有效性和安全性。检索MEDLINE、Embase和PubMed数据库，检索时间从建库至2025年4月30日。纳入了比较择期肝移植、肝切除术、胰十二指肠切除术和肝切除术后ciNPWT与传统敷料的随机和比较观察性研究。两名研究者独立进行筛选、提取数据并评估偏倚风险（RoB-2/ROBINS-I）。采用随机效应Mantel-Haenszel模型生成浅表SSI的合并风险比（RRs）；次要结局进行描述性报告。12项研究（7项随机对照试验、5项队列研究）纳入了15212例患者（356例接受ciNPWT；11651例为对照组），符合纳入标准。在所有试验中，装置应用持续3至7天。汇总分析显示，ciNPWT使浅表SSI相对降低29%（RR 0.71，95%CI 0.63-0.79；P<0.001），异质性可忽略不计（I² 0%）。绝对风险降低范围为0%至13%，与基线对照组SSI发生率呈正相关。深部/器官间隙SSI（RR 0.93，95%CI 0.79-1.09）和90天死亡率（RR 0.94，95%CI 0.69-1.28）未受影响。7项研究记录了中位住院时间缩短1至3天；只有2项达到统计学意义。与装置相关的不良事件很少见（1例血清肿，无皮肤坏死）。预防性使用ciNPWT可安全降低高危HPB手术后的浅表SSI，当基线SSI风险超过约10%时，绝对获益最大。其对深部感染和死亡率的影响可忽略不计。
