Clinical Scorecard: Evaluation of the Modified Smead–Jones Suture Technique for Closing Emergency Midline Laparotomy Incisions: A Systematic Review and Meta-Analysis

At a Glance

Key Highlights

• MSJ technique significantly reduces wound dehiscence risk compared to continuous sutures (RR=0.29, p=0.0006).
• MSJ technique significantly reduces wound infection risk compared to continuous sutures (RR=0.41, p=0.0002).
• No significant difference found in incisional hernia risk between MSJ, SJ, and continuous sutures.

Guideline-Based Recommendations

Diagnosis

• Wound dehiscence defined as separation of abdominal musculoaponeurotic layers within 30 days requiring intervention.
• Wound infection diagnosed by postoperative erythema, swelling, discharge, or need for antibiotics.
• Incisional hernia identified clinically or radiologically as fascial defect at laparotomy site.

Management

• Use of Modified Smead–Jones continuous suture technique recommended to reduce wound dehiscence and infection in emergency midline laparotomy closures.
• Non-absorbable polypropylene sutures (Prolene 1 loop) placed 2 cm from wound edges and 1 cm from linea alba used consistently.

Monitoring & Follow-up

• Monitor patients postoperatively for signs of wound infection and dehiscence within 30 days.
• Assess for incisional hernia clinically or with imaging during follow-up.

Risks

• Higher risk of wound dehiscence and infection associated with interrupted Smead–Jones suture technique compared to MSJ.
• No significant difference in incisional hernia risk among suture techniques.

Patient & Prescribing Data

403 patients undergoing emergency midline laparotomy incisions across five studies

MSJ continuous suture technique reduces postoperative wound complications and may improve recovery compared to continuous or interrupted SJ sutures.

Clinical Best Practices

• Adopt Modified Smead–Jones continuous suture technique for abdominal wall closure in emergency midline laparotomy to minimize wound complications.
• Use standardized suture placement: 2 cm from wound edges and 1 cm from linea alba with non-absorbable polypropylene sutures.
• Conduct thorough postoperative monitoring for early detection and management of wound infections and dehiscence.

References

• World Society of Emergency Surgery (WSES) guidelines
• Hernández et al. Network meta-analysis on reinforced tension line technique
• PRISMA statement for systematic reviews
• Cochrane Handbook for Systematic Reviews of Interventions
• ROB-2 tool for risk of bias assessment
• Newcastle–Ottawa Scale (NOS) for observational studies