The Effect of Fascial Closure With Triclosan-Coated Sutures on the Incidence of Abdominal Wall Dehiscence: An Individual Participant Data Meta-Analysis

Allard S Timmer; Niels Wolfhagen; Frank Pianka; Phillip Knebel; Christoph Justinger; Christos Stravodimos; Kosuke Ichida; Toshiki Rikiyama; József Baracs; András Vereczkei; Luca Gianotti; Marta Sandini; Jaime Ruiz-Tovar; Artur Marc-Hernández; Toru Nakamura; Marcel G W Dijkgraaf; Marja A Boermeester; Stijn W de Jonge

doi:10.3389/jaws.2024.13337

The Effect of Fascial Closure With Triclosan-Coated Sutures on the Incidence of Abdominal Wall Dehiscence: An Individual Participant Data Meta-Analysis

J Abdom Wall Surg. 2024 Sep 18:3:13337. doi: 10.3389/jaws.2024.13337. eCollection 2024.

Authors

Allard S Timmer^#^{1

2}, Niels Wolfhagen^#^{1

2}, Frank Pianka³, Phillip Knebel³, Christoph Justinger^{4

5}, Christos Stravodimos⁶, Kosuke Ichida⁷, Toshiki Rikiyama⁷, József Baracs⁸, András Vereczkei⁸, Luca Gianotti⁹, Marta Sandini¹⁰, Jaime Ruiz-Tovar¹¹, Artur Marc-Hernández¹², Toru Nakamura¹³, Marcel G W Dijkgraaf^#^{14

15}, Marja A Boermeester^#^{1

2}, Stijn W de Jonge^#^{1

2}

Affiliations

¹ Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.
² Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, Netherlands.
³ Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
⁴ Department of Surgery, Marienhaus Klinikum Hetzelstift, Neustadt an der Weinstrasse, Germany.
⁵ Department of Surgery, Albert-Ludwigs University Freiburg, Freiburg, Germany.
⁶ Department of Surgery, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany.
⁷ Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
⁸ Department of Surgery, Clinical Center, University of Pécs, Pécs, Hungary.
⁹ Department of Surgery, School of Medicine and Surgery, IRCCS San Gerardo Hospital, Milano-Bicocca University, Monza, Italy.
¹⁰ Department of Medical, Surgical, and Neurologic Sciences, University of Siena, Surgical Oncology Unit, Policlinico Le Scotte, Siena, Italy.
¹¹ Department of Surgery, Rey Juan Carlos University, Madrid, Spain.
¹² Department of Humanities and Social Sciences, University Isabel I, Burgos, Spain.
¹³ Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Sapporo, Japan.
¹⁴ Amsterdam University Medical Center (UMC) Location University of Amsterdam, Epidemiology and Data Science, Amsterdam, Netherlands.
¹⁵ Amsterdam Public Health, Methodology, Amsterdam, Netherlands.

^# Contributed equally.

Abstract

Introduction: Wound closure with triclosan-coated sutures (TCS) appears to reduce the risk of surgical site infection (SSI). Because there is a strong association between postoperative SSI and the development of acute abdominal wall dehiscence (AWD) after laparotomy, we hypothesized that the use of TCS for wound closure after laparotomy may also reduce the risk of AWD.

Methods: The MEDLINE, Embase, and CENTRAL databases were searched from their inception to 01 November 2022. Randomized trials that compared the use of TCS with identical but uncoated sutures for fascial closure were eligible if they could provide individual participant data (IPD) on AWD. From these trials, we only included in the analysis those subjects who underwent open abdominal surgery. The primary outcome was the incidence of AWD within 30 days postoperatively, requiring emergency reoperation. The certainty of evidence was assessed using the GRADE methodology (PROSPERO: CRD42019121173.

Results: We identified twelve eligible trials. Eight studies shared IPD. The incidence of AWD within 30 days after surgery was 27/1,565 (1.7%) in the TCS group vs. 40/1,430 (2.8%) in the control group (Relative Risk: 0.70 [95% confidence interval (CI) 0.44-1.11, I ² = 0%, τ² = 0.00]). The certainty of evidence was moderate after downgrading for imprecision. The incidence of incisional SSI was 163/1,576 (10.3%) vs. 198/1,439 (13.8%), RR 0.80 (95% CI 0.67-0.97).

Conclusion: We found no conclusive evidence to support the use of triclosan-coated sutures for the prevention of acute abdominal wall dehiscence after laparotomy. In these selected studies, a significant reduction in incisional SSI was observed.

Keywords: coated sutures; fascial closure; fascial dehiscence; triclosan-coated sutures; wound closure.

Copyright © 2024 Timmer, Wolfhagen, Pianka, Knebel, Justinger, Stravodimos, Ichida, Rikiyama, Baracs, Vereczkei, Gianotti, Sandini, Ruiz-Tovar, Marc-Hernández, Nakamura, Dijkgraaf, Boermeester and de Jonge.

Publication types

Review

Grants and funding

The authors declare that financial support was received for the research, authorship, and/or publication of this article. This study was supported by a grant from Ethicon. The funder of this study had no role in study design, data collection, data analysis, data interpretation nor writing of the report.