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Updated: Nov 22, 2025
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Published on: May 10, 2024
Prophylactic Negative Pressure Wound Therapy After Laparotomy for Gynecologic Surgery: A Randomized Controlled Trial
Mario M Leitao1, Qin C Zhou, Maria B Schiavone
1Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, the Department of Obstetrics and Gynecology, Weill Cornell Medical College, and the Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, New York; the Division of Gynecologic Oncology, Hartford Healthcare Cancer Institute, Hartford, Connecticut; the Lehigh Valley Cancer Institute, Allentown, Pennsylvania; and the Miami Cancer Institute, Miami, Florida.
Objective:
To estimate the effectiveness of prophylactic negative pressure wound therapy in patients undergoing laparotomy for gynecologic surgery.
Methods:
We conducted a randomized controlled trial. Eligible, consenting patients, regardless of body mass index (BMI), who were undergoing laparotomy for presumed gynecologic malignancy were randomly allocated to standard gauze or negative pressure wound therapy. Patients with BMIs of 40 or greater and benign disease also were eligible. Randomization, stratified by BMI, occurred after skin closure. The primary outcome was wound complication within 30 (±5) days of surgery. A sample size of 343 per group (N=686) was planned.
Results:
From March 1, 2016, to August 20, 2019, we identified 663 potential patients; 289 were randomized to negative pressure wound therapy (254 evaluable participants) and 294 to standard gauze (251 evaluable participants), for a total of 505 evaluable patients. The median age of the entire cohort was 61 years (range 20-87). Four hundred ninety-five patients (98%) underwent laparotomy for malignancy. The trial was eventually stopped for futility after an interim analysis of 444 patients. The rate of wound complications was 17.3% in the negative pressure wound therapy (NPWT) group and 16.3% in the gauze group, absolute risk difference 1% (90% CI -4.5 to 6.5%; P=.77). Adjusted odds ratio controlling for estimated blood loss and diabetes was 0.99 (90% CI 0.62-1.60). Skin blistering occurred in 33 patients (13%) in the NPWT group and in three patients (1.2%) in the gauze group (P<.001).
Conclusion:
Negative pressure wound therapy after laparotomy for gynecologic surgery did not lower the wound complication rate but did increase skin blistering.
Clinical Trial Registration:
ClinicalTrials.gov, NCT02682316.
Funding Source:
The protocol was supported in part by KCI/Acelity.
