Comparative outcomes of reinforced tension-line sutures versus standard closure techniques in patients undergoing laparotomy: a systematic review and meta-analysis
Mikhail, Rama H G Hajibandeh, Shahin Hajibandeh, Shahab Smith, Marty Ban, Ee Jun Jacobs, Rodney McKay, Siobhan C
Mikhail, Rama H G
Hajibandeh, Shahin
Hajibandeh, Shahab
Smith, Marty
Ban, Ee Jun
Jacobs, Rodney
McKay, Siobhan C
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Publication date
2026-01-14
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Abstract
Background: The reinforced tension-line suture (RTLS) technique distributes mechanical stress more evenly than traditional closure when closing a laparotomy wound, potentially reducing incisional hernia (IH) risk. We aimed to compare outcomes of RTLS versus standard closure techniques in patients undergoing laparotomy.
Methods: Systematic search of PubMed, MEDLINE, Web of Science, and bibliographic reference lists was conducted (last search: 26 January 2025). The protocol was registered with PROSPERO. Comparative studies reporting outcomes of RTLS versus other closure methods were included and their risk of bias was assessed. IH, Clavien-Dindo (C-D) ≥ III complications, wound dehiscence, wound infection, and procedure time were the evaluated outcome measures. Odds ratios (OR) for dichotomous outcomes and mean differences (MD) for continuous variables were determined. Heterogeneity was assessed using I2 and Cochran's Q test.
Results: Five comparative studies (four randomised and one observational) enrolling 708 patients who had their laparotomy wound closed using RTLS (n = 393) or standard closure (n = 315) were included. Use of RTLS significantly reduced risk of IH compared to standard technique (5.6% vs. 18.1%, OR 0.24; 95% CI: 0.15-0.38; p = 0.005). However, no significant differences were found in C-D ≥ III complications (10.2% vs. 3.2%, OR 0.81; 95% CI: 0.18-3.54, p = 0.62), wound dehiscence (2.3% vs. 6.9%, OR 0.34; 95% CI: 0.06-1.84, p = 0.62), wound infection (9.0% and 10.4%, OR 0.34; 95% CI: 0.06-1.84, p = 0.62) or procedure time (MD 23.50; 95% CI: -59.88-106.87, p = 0.16) between two groups.
Conclusions: RTLS seems to significantly reduce IH incidence after laparotomy without increasing post-operative morbidities or procedure time. Further Level 1 evidence is needed.
Citation
Mikhail RHG, Hajibandeh S, Hajibandeh S, Smith M, Ban EJ, Jacobs R, McKay SC. Comparative Outcomes of Reinforced Tension-Line Sutures Versus Standard Closure Techniques in Patients Undergoing Laparotomy: A Systematic Review and Meta-Analysis. ANZ J Surg. 2026 Jan 14. doi: 10.1111/ans.70439. Epub ahead of print.
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Article