Reclosure of the disrupted laparotomy wound: a systematic review.
OBJECTIVE
To review systematically all prospective, randomized trials published in English quantifying the success of reclosure of the disrupted laparotomy wound.


METHODS
The MEDLINE/PubMed, EMBASE, CINAHL, and Cochrane databases were searched from 1966 to 2004. References were hand-searched and their authors contacted to identify all published and unpublished eligible studies.


METHODS
We included all prospective, randomized trials measuring successful reclosure of disrupted laparotomy wounds in human subjects. Studies with fascial disruption, subfascial abscess, or ongoing contamination were excluded. Of over 2,098 potentially relevant articles, 8 were included, incorporating 348 patients.


RESULTS
Two authors determined study inclusion. One investigator abstracted data, and a second checked for accuracy. The main outcome was successful healing after wound reclosure. Timing of reclosure, utility of antibiotics, and reclosure techniques were also analyzed. Successful healing after reclosure ranged between 81% and 100%. Failed healing included both superficial wound separation and reaccumulation of abscess. No serious morbidity or mortality was reported. Compared with healing by secondary intention, reclosure resulted in faster healing times (16-23 days versus 61-72 days), and in the one study that evaluated it, 6.4 fewer office visits. The optimal timing and technique for reclosure and the utility of antibiotics were inconclusive.


CONCLUSIONS
Reclosure of disrupted laparotomy wounds was successful in over 80% of patients. Failed reclosure resulted in no life-threatening complications. Reclosure of disrupted laparotomy wounds is safe and decreases healing times.
Wechter
Mary Ellen
ME
Division of Advanced Laproscopy and Pelvic Pain, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina 27599, USA. mwechter@med.unc.edu
Pearlman
Mark D
MD
Hartmann
Katherine E
KE
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000379:methods; D011183:Postoperative Complications; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012086:Reoperation / Q000379:methods; D013997:Time Factors; D014945:Wound Healing
D000900:Anti-Bacterial Agents