Interrupted versus continuous fascial closure after emergency midline laparotomy: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND: Wound dehiscence after emergency midline laparotomy is a severe complication linked to high morbidity and mortality. While continuous closure is standard in elective surgery, its superiority is not established in high-risk emergency settings, where patient factors like infection and malnutrition can compromise healing. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to compare the efficacy and safety of interrupted versus continuous fascial closure techniques after emergency midline laparotomy. METHODS: A comprehensive search of PubMed, Scopus, CENTRAL, Google Scholar, and Web of Science was conducted for RCTs up to October 2025. The primary outcome was wound dehiscence. Secondary outcomes included wound infection, incisional hernia, and length of hospital stay (LoS). Risk ratios (RR) and mean differences (MD) were pooled using STATA 19.5, with 95% confidence intervals (CI). RESULTS: Twenty-five RCTs involving 3,548 patients were included. Interrupted closure significantly reduced the risk of wound dehiscence compared to continuous closure (RR: 0.47, 95% CI [0.38, 0.87]; p < 0.001). There was no significant difference in wound infection (RR: 0.91, 95% CI [0.76, 1.09]; p = 0.31) or incisional hernia (RR: 0.83, 95% CI [0.57, 1.22]; p = 0.34). However, interrupted closure was also associated with a significantly shorter LoS (MD: - 3.52 days, 95% CI [- 4.75, - 2.29]; p < 0.001). CONCLUSION: In the high-risk emergency midline laparotomy setting, current evidence suggests that interrupted fascial closure may be associated with a reduction in wound dehiscence and a shorter LoS compared to continuous closure. However, given the risk of bias and clinical heterogeneity among the included studies, these findings should be interpreted with caution, and further high-quality, standardized trials are warranted.