Negative Pressure Wound Therapy for Emergency Laparotomy: A Meta-Analysis With Trial Sequential Analysis
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Updated: Nov 1, 2026
Surgical Closure of Equine Abdomen, Prevention, and Management of Incisional Complications
Published on: May 10, 2024
Abdullah M Alharran1, Sarah Saqer Alblooshi2, Sarah M Sabzali1
1College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain.
Introduction:
Surgical site infection (SSI) remains a frequent and clinically important complication after emergency laparotomy. Closed-incision negative pressure wound therapy (NPWT) has been proposed to reduce wound-related complications, but evidence in emergency laparotomy remains mixed.
Methods:
Databases were searched from inception to January 2026. Randomized controlled trials comparing NPWT with standard dressings after emergency laparotomy were included. The primary outcome was SSI. Secondary outcomes were seroma, wound dehiscence, and length of hospital stay (LOS). Random-effects meta-analyses were performed using risk ratios (RRs) or mean differences with 95% confidence intervals (CIs). Trial sequential analysis was used to assess the robustness of cumulative evidence. Certainty of evidence was assessed using Grading of Recommendations Assessment Development and Evaluation.
Results:
Eight randomized controlled trials were included. The pooled SSI estimate favored NPWT (8 studies, n = 1348; RR, 0.46; 95% confidence interval (CI), 0.28 to 0.76; P = 0.0021), but heterogeneity was substantial (I2 = 71.1%), the largest trial was neutral, and marked asymmetry suggested substantial small study effects. NPWT was also associated with significantly lower risks of seroma (4 studies, n = 1057; RR, 0.60; 95% CI, 0.38 to 0.93; P = 0.0232; I2 = 0.0%) and wound dehiscence (7 studies, n = 1287; RR, 0.59; 95% CI, 0.37 to 0.93; P = 0.0238; I2 = 32.8%). No significant difference was observed for LOS (7 studies, n = 1287). Certainty of evidence was low for SSI and LOS, and moderate for seroma and wound dehiscence.
Conclusions:
In emergency laparotomy, prophylactic NPWT showed a directionally favorable but uncertain SSI signal and was associated with lower risks of seroma and wound dehiscence, but not shorter hospital stay. The SSI estimate should be interpreted cautiously because of substantial heterogeneity, marked small study effects, and the neutral result of the largest trial. These findings support a selective rather than routine use of NPWT.