Wound edge protector for prevention of surgical site infection in laparotomy: an updated systematic review and meta-analysis

Background An updated meta-analysis based on randomized controlled trials (RCTs) was conducted to evaluate the efficacy of wound edge protector (WEP) in the prevention of surgical site infection (SSI) in patients undergoing laparotomies. Methods Meta-analysis was conducted using Review Manager 5.2. The pooled risk ratio was estimated with random-effect model. Medline, Embase, the Cochrane library, reference lists and conference proceedings were data sources. Two independent reviewers screened studies for inclusion and data extraction. Eligible trials were RCTs enrolling patients accepting laparotomies to assess the effectiveness of WEP. Results Eleven RCTs totalling 2344 patients met the inclusion criteria. Six trials (1589 patients) testing the single-ring design WEP did not show a statistically significant reduction in SSI of laparotomy (RR 0.76, 95% CI 0.51–1.12). Pooled analysis of the five trials (755 patients) that tested the effect of dual-ring design WEP on SSI showed a significant reduction (RR 0.29, 95% CI 0.15–0.55). The combined data of the 11 trials favoured the effect of WEP (RR 0.58, 95% CI 0.39–0.87). Analysis adjusted by the degrees of contamination revealed that WEP is effective in reducing the incidence of SSI after laparotomy of contamination incision (RR 0.43, 0.26–0.72) but failed to demonstrate such effect in clean/contaminated and dirty incisions (RR 0.72, 95% CI 0.43–1.21; RR 0.82, 95% CI 0.43–1.55, respectively). Conclusions Our exploratory meta-analysis suggests that WEP reduces the incidence of SSI in patients receiving laparotomies, especially in the circumstance of dual-ring WEP and in contaminated incisions. In order to fully assess the effectiveness of WEP, large-scale and well-designed RCTs are still needed in the future.