Wound protectors in reducing surgical site infections in lower gastrointestinal surgery: an updated meta-analysis



Surgical site infection (SSI) is a common complication in gastrointestinal surgery. Wound protection devices are being increasingly used in the attempt to reduce infection rates. We performed a meta-analysis to determine if wound protectors reduce the incidence of SSIs in lower gastrointestinal surgery.


MEDLINE and EMBASE databases were searched between 1946 and 2016. Randomized controlled trials comparing wound protector versus no wound protector in lower gastrointestinal surgery were included. Our primary outcome was surgical site infection. Subgroup analysis was conducted comparing single-ring versus dual-ring wound protectors.


Twelve RCTs with 3029 participants were included. There was a significant decrease in the odds of developing SSI in the wound protector group (OR 0.64, 95% CI 0.45–0.90, P < 0.01, I 2 = 55%). There was evidence of a subgroup effect (P = 0.01) with dual-ring wound protectors associated with significantly lower incidence of SSIs (OR 0.31, 95% CI 0.18–0.52, P < 0.0001, I 2 = 12%), which was not appreciated in the single-ring group (OR 0.84, 95% CI 0.67–1.04, P = 0.11, I 2 = 0%).


Wound protector use is associated with decreased odds of developing SSI in patients undergoing lower gastrointestinal surgery. There was a subgroup effect when comparing dual-ring to single-ring devices.

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Author information




LZ: acquisition, analysis, and interpretation of data, drafting of the article, revision of the article. BE: acquisition of data, drafting of the article, revision of the article. SVP: conception and design, analysis and interpretation of data, revision of the article. All authors had final approval of the article.

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Correspondence to Lisa Zhang.

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Drs. Lisa Zhang, Basheer Elsolh, and Sunil Patel have no conflict of interest or financial ties to disclose.

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Zhang, L., Elsolh, B. & Patel, S.V. Wound protectors in reducing surgical site infections in lower gastrointestinal surgery: an updated meta-analysis. Surg Endosc 32, 1111–1122 (2018). https://doi.org/10.1007/s00464-017-6012-0

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  • Surgical site infection
  • Wound infection
  • Colorectal surgery
  • Appendix
  • Gastrointestinal surgery