腹腔鏡手術における強化テンションライン縫合術と標準閉鎖術の術後創傷ヘルニアリスクに関する比較：システマティックレビューおよびメタアナリシス

The reinforced tension-line suture (RTLS) technique distributes mechanical stress more evenly than traditional closure when closing a laparotomy wound, potentially reducing incisional hernia (IH) risk. We aimed to compare outcomes of RTLS versus standard closure techniques in patients undergoing laparotomy.

Systematic search of PubMed, MEDLINE, Web of Science, and bibliographic reference lists was conducted (last search: 26 January 2025). The protocol was registered with PROSPERO. Comparative studies reporting outcomes of RTLS versus other closure methods were included and their risk of bias was assessed. IH, Clavien-Dindo (C-D) ≥ III complications, wound dehiscence, wound infection, and procedure time were the evaluated outcome measures. Odds ratios (OR) for dichotomous outcomes and mean differences (MD) for continuous variables were determined. Heterogeneity was assessed using I² and Cochran's Q test.

Five comparative studies (four randomised and one observational) enrolling 708 patients who had their laparotomy wound closed using RTLS (n = 393) or standard closure (n = 315) were included. Use of RTLS significantly reduced risk of IH compared to standard technique (5.6% vs. 18.1%, OR 0.24; 95% CI: 0.15-0.38; p = 0.005). However, no significant differences were found in C-D ≥ III complications (10.2% vs. 3.2%, OR 0.81; 95% CI: 0.18-3.54, p = 0.62), wound dehiscence (2.3% vs. 6.9%, OR 0.34; 95% CI: 0.06-1.84, p = 0.62), wound infection (9.0% and 10.4%, OR 0.34; 95% CI: 0.06-1.84, p = 0.62) or procedure time (MD 23.50; 95% CI: -59.88-106.87, p = 0.16) between two groups.

RTLS seems to significantly reduce IH incidence after laparotomy without increasing post-operative morbidities or procedure time. Further Level 1 evidence is needed.