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Closure of the abdominal incision: can we do a meta-analysis?
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A meta-analysis is the statistical analysis of a large collection of analysis results from individual studies for the purpose of integrating the findings. This is a formal process used increasingly in human medicine and to a lesser extent in veterinary medicine and most commonly combines results from a series of controlled trials (Dohoo et al 2003).
Meta-analysis of human midline incisional closure
Meta-analysis of closure of midline abdominal incisions has utilised incisional herniation formation as a primary outcome of interest with secondary outcomes measured being infection, dehiscence, pain and suture sinus formation. Riet et al (2002) evaluated 15 randomised controlled trials (RCTs) with a total of 6,566 patients and Patel et al (2017) evaluated 55 RCT’s with a total of 19,174 patients. The key findings were reduced risk of incisional hernia development with monofilament versus multifilament sutures, reduced risk of wound pain or suture sinus formation with absorbable and slowly absorbable continuous sutures. Patel et al (2017) concluded that there were serious concerns about the design and reporting of many trials, that comparator arms differed by > 1 component, groups were very heterogenous (e.g. emergency and elective surgeries, different types of surgical procedures) and that more large, high quality trials were needed. This included proper randomisation and allocation to treatment groups and rigorous blinded assessment of outcomes. [...]
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