comparison of interrupted versus continuous closure in abdominal wound repair: a meta-analysis of 23 trials

Objective: There is a lack of consensus among surgeons over interrupted versus continuous methods of abdominal wound closure. The objective of this study was to perform a meta-analysis to estimate the pooled odds ratio (OR) for dehiscence and incisional hernia in the interrupted technique of laparotomy wound closure as compared to the continuous technique. Methods: All randomized, controlled trials comparing continuous and interrupted methods of laparotomy wound closure, with burst abdomen and/or incisional hernia as the outcomes, were included in the meta-analysis. MEDLINE, Clinical Evidence and the Cochrane Library were searched. Burst abdomen and incisional hernia were the two primary outcomes. Results: Twenty-three studies were identified, with a total of 10,900 patients. The interrupted method of closure was associated with significantly less dehiscence as compared with the continuous method (OR, 0.576; p =0.014; relative risk reduction, 39.8%; number needed to treat, 143). The interrupted technique was also found to be better in the nonabsorbable suture, vertical incision and mass closure subgroups. However, no difference in the hernia risk was found between the two methods. Conclusion: Interrupted laparotomy wound closure reduces the odds of dehiscence by half compared with continuous wound closure.