TPT 3.19 Safety over Speed: A Meta-Analysis of Continuous versus Interrupted Closure in 4,605 Emergency Laparotomies

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ID: 324104
2026
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Abstract
Abstract Background Burst abdomen remains a catastrophic complication of midline laparotomy, particularly in high-risk emergency settings. While continuous suturing is faster, its safety profile regarding wound failure remains controversial. This study aimed to compare the efficacy of continuous versus interrupted fascial closure in adult midline laparotomy, specifically assessing fascial dehiscence, incisional hernia, and surgical site infection (SSI). Methods Standard medical databases MEDLINE, Embase, Pubmed and Cochrane Library were searched to find randomised controlled trials comparing continuous versus interrupted fascial closure. Statistical analysis was performed using Review Manager Software 5.4, and the meta-analysis was performed with the random effects model analysis. Results Thirty-five studies involving 4,605 emergency patients were included. Meta-analysis demonstrated that continuous fascial closure was associated with a significantly higher rate of fascial dehiscence compared to interrupted closure (Odds Ratio [OR] 2.41; 95% Confidence Interval [CI] 1.94–2.99; z = 7.97; p < 0.00001). Conversely, there was no statistically significant difference between techniques regarding the incidence of incisional hernia (OR 1.78; 95% CI 0.97–3.28; z = 1.85; p = 0.06) or SSI (OR 0.98; 95% CI 0.76–1.26; z = 0.18; p = 0.86). Conclusions The results provide high-level evidence that interrupted fascial closure significantly reduces the risk of burst abdomen without increasing the risk of incisional hernia or infection. In high-risk and emergency laparotomies, where tissue integrity is compromised, surgeons should prioritise the safety of interrupted closure over the speed of continuous techniques, warranting a re-evaluation of the default technique in emergency settings.
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Authors Abir Mamun, Yumna Saleem, Yahya El-Tahlawy
Journal the british journal of surgery
Year 2026
DOI
10.1093/bjs/znag087.202
URL
https://doi.org/10.1093/bjs/znag087.202
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