Closed incision negative pressure wound therapy after emergency laparotomy: a systematic review and Meta-analysis of randomized controlled trials.

Abstract

<h4>Purpose</h4>Emergency laparotomy is associated with high rates of postoperative wound complications, contributing substantially to patient morbidity and healthcare burden. Closed incision negative pressure wound therapy (ciNPWT) has been proposed as a prophylactic strategy to reduce wound-related complications; however, its effectiveness in the emergency laparotomy setting remains uncertain. We evaluated whether ciNPWT reduces wound complications after emergency laparotomy compared with standard dressings.<h4>Methods</h4>This study is a systematic review and meta-analysis of randomized controlled trials (RCTs). Six databases and trial registries were systematically searched for RCTs from inception to October 10, 2025, with the search subsequently updated using automated database alerts (RSS) up to the time of manuscript submission.<h4>Results</h4>Six randomized controlled trials (1208 patients) were included. Compared with standard dressings, ciNPWT reduced overall wound morbidity (RR 0.49, 95% CI 0.38-0.62; I² = 0%) and overall SSI (RR 0.40, 95% CI 0.26-0.61; I² = 0%). ciNPWT also reduced superficial SSI (RR 0.46, 95% CI 0.24-0.85) and wound dehiscence (RR 0.40, 95% CI 0.20-0.80). No significant differences were observed for seroma (RR 0.59, 95% CI 0.34-1.01), length of hospital stay (MD - 0.43 days, 95% CI- 1.14 to 0.29), mortality (RR 1.18, 95% CI 0.64-2.15), or 30-day complications (RR 0.98, 95% CI 0.85-1.15).<h4>Conclusion</h4>In adult patients undergoing emergency laparotomy with primary abdominal closure, ciNPWT significantly reduces key incision-related complications, particularly superficial SSI and wound dehiscence. Its clinical benefit appears confined to incision-level outcomes, with no effect on systemic or multifactorial postoperative endpoints. These findings support the selective use of ciNPWT in high-risk emergency laparotomy patients and highlight the need for standardized application protocols and longer-term outcome assessment.