The use of negative pressure wound therapy following stoma reversal: a systematic review and meta-analysis of randomized controlled trials.

Background: Stoma reversal is a contaminated surgery with many patients experiencing significant wound complications that contribute to patient morbidity. It is believed that the use of prophylactic negative pressure wound therapy (NPWT) may enhance wound healing and help reduce the risk of developing surgical site infections (SSI). However, there is conflicting research regarding its effectiveness following stoma reversal. Our systematic review aims to evaluate the available randomized data to determine if the use of prophylactic NPWT after stoma reversal improves the duration of wound healing and reduces rates of postoperative complications.

Methods: A comprehensive search of literature published up to January 2025 was conducted using the following databases: PubMed, Embase, Medline, and Cochrane Library. The included trials were randomized controlled trials that investigated the effect of NPWT following stoma reversal. The primary outcome was the time to complete wound healing. Secondary outcomes included the incidence of wound complications, SSI, hematomas, and the length of hospital stay.

Results: Six randomised control trials were included, with 332 patients, of which 171 of these underwent NPWT. There was a significant reduction in time to complete wound healing (OR - 2.53, 95% CI - 3.82 to - 1.24, p = 0.0001, I2 = 45%) and wound healing at 42 days (OR 0.36, 95% CI 0.14 - 0.88, p = 0.03, I2 = 0%) in the NPWT group. There was no significant difference in any wound complications (OR 0.72, 95% CI 0.23-2.28, p = 0.58, I2 = 42%), SSI rates (OR 0.95, 95% CI 0.27-3.29, p = 0.94, I2 = 38%) or haematoma rates (OR 0.21, 95% CI 0.03-1.27, p = 0.09, I2 = 0%) between the groups. There was no significant difference in length of stay (OR - 0.02, 95% CI - 1.21-1.18, p = 0.98, I2 = 66%).

Conclusions: The use of NPWT after stoma reversal significantly reduces the time needed for complete wound healing while maintaining a comparable rate of wound complications and length of hospital stay. Therefore, NPWT may be valuable in optimizing postoperative recovery and enhancing patient outcomes.