Prophylactic negative pressure wound therapy for closed laparotomy incisions after ventral hernia repair: A systematic review and meta-analysis

Abstract

PurposeTo evaluate the efficacy of prophylactic negative pressure wound therapy (pNPWT) in preventing surgical site infection (SSI), hernia recurrence and other wound complications following closed laparotomy incisions following ventral hernia repair (VHR). MethodsA comprehensive literature search of PubMed, the Cochrane Central Register of Controlled Trials, Embase and ClinicalTrials.gov databases was performed from inception until June 30, 2021, to identify all online English publications comparing the use of pNPWT with standard dressing for closed laparotomy incision following VHR. ResultsOne RCT and eleven retrospective cohort studies involving 1355 patients satisfied the basic inclusion criteria. The use of pNPWT reduced SSI (OR = 0.39 [95% CI: 0.24–0.62] P < 0.0001) and surgical site occurrence (SSO) (OR = 0.51 [95% CI: 0.27–0.98] P = 0.04). No statistically significant difference was detected in the incidence of hernia recurrence (OR = 0.61 [95% CI: 0.30–1.26] P = 0.18), seroma (OR = 0.70 [95% CI: 0.48–1.03]P = 0.07), hematoma (OR = 0.77 [95% CI: 0.33–1.81]P = 0.55) and wound dehiscence (OR = 0.68 [95% CI: 0.43–1.08]P = 0.10). ConclusionUse of pNPWT for closed laparotomy incisions following ventral hernia repair can significantly reduce the rate of postoperative surgical site infection (especially for superficial SIS) and surgical site occurrences. The number needed to treat (NNT) for preventing one occurrence of SSI is 9 patients. However, further research and more high quality studies are required to assess the effectiveness and assist in clarifying the role of pNPWT for closed laparotomy incisions following ventral hernia repair, preferentially in high-risk populations of developing SSI.