Modified Smead-Jones suture for closure of emergency midline laparotomy incision: systematic review and meta-analysis

Abstract

Midline laparotomy incision is mostly used in emergent surgery, especially in hemodynamic instability patients. We aim to compare the Modified Smead-Jones (MSJ) and Smead-Jones (SJ) sutures against conventional continuous suture in midline laparotomy closure. PubMed, Scopus, Web of Science, and Ovoid were searched. We utilized Revman 5.4.1 for statistical analysis. Five studies involving 403 patients were included. Compared to continuous sutures, MSJ showed a significant reduction in wound dehiscence, wound infection, and hospital stay (RR = 0.29, 95% CI [0.14-0.59], p = 0.0006), (RR = 0.41, 95% CI [0.26-0.65], p = 0.0002), and (MD = - 4.50, 95% CI [- 5.43 to - 3.57], p = 0.00001). Conversely, the SJ subgroup showed no statistically significant difference in wound dehiscence, wound infection, and hospital stay. Also, both techniques, MSJ and SJ, showed no significant difference in incisional hernia risk (RR = 0.17, 95% CI [0.02-1.33], p = 0.09) and (RR = 5.16, 95% CI [0. 26-103.27], p = 0.28), respectively. MSJ follows the same far-near-near-far pattern as SJ but is applied continuously rather than interrupted. The MSJ suture technique might be promising in reducing wound dehiscence, infection, and hospital stay compared to conventional continuous closure. However, future large-scale RCTs with standardized methodologies and extended follow-up are essential to determine whether MSJ should be established as the preferred technique for midline laparotomy closure.

Keywords: Far-near-near-far; Incisional hernia; Laparotomy; Modified Smead Jones; Wound dehiscence.

Fig. 1

Meta-analysis results of wound-related complications and hospital stay. (A) Wound dehiscence: Risk ratio (RR) with 95% confidence interval (CI). (B) Wound infection: RR with 95% CI. (C) Incisional hernia: RR with 95% CI. (D) Hospital stay: Mean difference (MD) with 95% CI