Meta-analysis on Materials and Techniques for Laparotomy Closure: The MATCH Review

Area of Science:

• Surgical Innovation
• Evidence-Based Medicine
• Abdominal Surgery

Background:

• Laparotomy closure is critical for preventing complications.
• Incisional hernias are a significant concern after abdominal surgery.
• Optimal closure materials and techniques require robust evidence.

Purpose of the Study:

• To systematically review and meta-analyze closure materials and suture techniques for laparotomies.
• To evaluate their impact on incisional hernia rates, burst abdomen, and surgical site infection.
• To identify evidence-based recommendations for surgical closure practices.

Main Methods:

• Systematic literature search conducted until September 2017.
• Inclusion of 23 randomized controlled trials (RCTs) in the meta-analysis.
• Quality appraisal of RCTs by at least 3 independent assessors.

Main Results:

• No suture material (absorbable or non-absorbable) demonstrated superiority in reducing incisional hernias.
• Continuous suturing showed no significant advantage over interrupted suturing for hernia prevention.
• A significant reduction in incisional hernias was observed with small bites using slowly absorbable sutures in continuous closure (OR 0.41).

Conclusions:

• High-quality evidence for the optimal suture material or technique to prevent incisional hernias after laparotomy is lacking.
• Utilizing slowly absorbable sutures with continuous suturing and small tissue bites significantly reduces incisional hernia rates.
• Further research is needed to establish definitive guidelines for laparotomy closure.