Evaluation of Modified Smead–Jones Suture Technique for Emergency Midline Laparotomy Closure

Overview

This systematic review and meta-analysis compared the Modified Smead–Jones (MSJ) and Smead–Jones (SJ) suture techniques to continuous sutures in emergency midline laparotomy closures. MSJ significantly reduced wound dehiscence and wound infection rates compared to continuous sutures, while SJ showed no significant benefit. No significant differences were found in incisional hernia risk or hospital stay duration.

Background

Midline laparotomy is a common surgical approach for emergency abdominal procedures but carries risks of wound complications such as incisional hernia, wound dehiscence, and surgical site infections, especially in hemodynamically unstable patients. Optimal closure techniques remain unclear, with recent evidence favoring reinforced tension line methods. The Modified Smead–Jones suture (MSJ), a continuous far-near-near-far technique, has been proposed to improve outcomes by approximating the rectus sheath, peritoneum, and muscle as a cohesive unit. This review aims to clarify the efficacy of MSJ compared to SJ and continuous sutures.

Data Highlights

Key Findings

• MSJ significantly reduces wound dehiscence risk compared to continuous sutures (RR 0.29, p=0.0006).
• SJ does not significantly affect wound dehiscence risk compared to continuous sutures (RR 1.45, p=0.49).
• MSJ significantly lowers wound infection rates versus continuous sutures (RR 0.41, p=0.0002).
• SJ shows no significant difference in wound infection rates compared to continuous sutures (RR 1.03, p=0.93).
• Neither MSJ nor SJ demonstrated statistically significant differences in incisional hernia risk.
• Hospital stay duration was not significantly different between suture techniques.

Clinical Implications

The Modified Smead–Jones suture technique offers a clinically meaningful reduction in postoperative wound dehiscence and infection in emergency midline laparotomy closures, suggesting it may be preferred over continuous sutures. Surgeons should consider adopting MSJ to improve wound healing outcomes, while recognizing that incisional hernia rates and hospital stay lengths appear unaffected by suture choice. Further high-quality studies are warranted to confirm these findings and optimize closure protocols.

Conclusion

This meta-analysis supports the Modified Smead–Jones suture as an effective technique to reduce wound complications after emergency midline laparotomy. Its use may enhance patient recovery by lowering wound dehiscence and infection rates without increasing incisional hernia risk.

References

1. Hernández et al. 2023 -- Network meta-analysis of closure techniques
2. World Society of Emergency Surgery (WSES) Guidelines 2022 -- Abdominal wall closure
3. Smead–Jones Original Technique Description
4. PROSPERO Registration CRD42024525979
5. Cochrane Handbook for Systematic Reviews of Interventions