EP 631 Who Benefits from Incisional Negative Pressure Wound Therapy after Emergency Laparotomy? Research Gaps, Unmet Needs, and a Proposed Reporting Framework
Francielle Antonini, Maria de Paiva, Marcílio Filho, Fabricio Nascimento, Leticia Gatti Fonseca, Gunther PimentaAbstract
Aim
To identify key unresolved questions and research gaps in the use of incisional negative pressure wound therapy (NPWT) after emergency laparotomy, and to propose a standardised reporting framework to guide future trials and meta-analyses.
Methods
Research gaps were identified through critical appraisal of all randomised controlled trials included in a recent systematic review and meta-analysis, alongside a focused narrative review of the literature on incisional NPWT in emergency laparotomy. Sources of heterogeneity, risk of bias, outcome definition variability, patient selection, and differences in intervention protocols were examined. Based on this synthesis, a minimum reporting checklist was developed.
Results
Several clinically important gaps were identified. Evidence is insufficient to determine which patient subgroups benefit most from NPWT, particularly among high-risk populations such as elderly, septic, malnourished, and heavily contaminated cases. Substantial unexplained heterogeneity in surgical site infection outcomes persists due to inconsistent reporting of wound classification, contamination severity, and baseline risk. Intervention protocols vary widely, with no consensus on pressure settings, duration of therapy, or dressing changes. Patient-centred and long-term outcomes, including quality of life, incisional hernia, and late wound complications, are infrequently reported, and robust cost-effectiveness data are lacking. A standardised minimum dataset and reporting checklist is therefore proposed.
Conclusion
NPWT may reduce surgical site infections and complications after emergency laparotomy, but methodological limitations hinder its effectiveness. The proposed reporting framework aims to enhance study design, reduce heterogeneity, and improve trial quality, facilitating better patient selection and clearer assessment of NPWT's clinical and economic value in emergency surgery.