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Triclosan-coated sutures and surgical site infection in abdominal surgery: the TRISTAN review, meta-analysis and trial sequential analysis

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Abstract

Introduction

Surgical site infection (SSI) is a frequent complication of abdominal surgery causing increased morbidity. Triclosan-coated sutures are recommended to reduce SSI. The aim of this systematic review and meta-analysis was to evaluate the evidence from randomized controlled trials (RCT) comparing the rate of SSI in abdominal surgery when using triclosan-coated or uncoated sutures for fascial closure.

Methods

A systematic literature search was conducted using Medline, EMBASE, the Cochrane library, CINAHL, Scopus and Web of Science including publications until August 2017. The quality of the RCTs was evaluated using critical appraisal checklists from SIGN. Meta-analyses and trial sequential analysis were performed with Review Manager v5.3 and TSA software, respectively.

Results

Eight RCTs on abdominal wall closure were included in the meta-analysis. In an overall comparison including both triclosan-coated Vicryl and PDS sutures for fascial closure, triclosan-coated sutures were superior in reducing the rate of SSI (OR 0.67; 0.46–0.98). When evaluating PDS sutures separately, there was no effect of triclosan-coating on the rate of SSI (OR 0.85; 0.61–1.17). Trial sequential analysis showed that the required information size (RIS) of 797 patients for triclosan-coated Vicryl sutures was almost reached with an accrued information size (AIS) of 795 patients. For triclosan-coated PDS sutures an AIS of 2707 patients was obtained, but the RIS was estimated to be 18,693 patients.

Conclusion

Triclosan-coated Vicryl sutures for abdominal fascial closure decrease the risk of SSI significantly and based on the trial sequential analysis further RCTs will not change that outcome. There was no effect on SSI rate with the use of triclosan-coated PDS sutures for abdominal fascial closure, and it is unknown whether additional RCTs will change that.

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Authors and Affiliations

  1. Dept. of Surgery, Zealand University Hospital, Lykkebaekvej 1, 4600, Koege, Denmark

    N. A. Henriksen

  2. Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands

    E. B. Deerenberg

  3. Lithuanian University of Health Sciences, Kaunas, Lithuania

    L. Venclauskas

  4. Hernia Center, Wilhelminenspital, Vienna, Austria

    R. H. Fortelny

  5. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK

    J. M. Garcia-Alamino

  6. University Hospitals, KU Leuven, Leuven, Belgium

    M. Miserez

  7. Maria Middelares, Ghent, Belgium

    F. E. Muysoms

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  1. N. A. Henriksen
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  4. R. H. Fortelny
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Correspondence to N. A. Henriksen.

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NH, ED, LV, RF and JG declare no conflict of interest. MM declares conflict of interest not directly related to the submitted work: grants and personal fees (speaker) from Aspide, Bard and Gore and is editor-in-chief of Hernia Journal, Springer. FM declares conflict of interest not directly related to the submitted work: grants and personal fees (consultancy and speaker) from Medtronic and Dynamesh and proctoring for Intuitive Surgical.

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Henriksen, N.A., Deerenberg, E.B., Venclauskas, L. et al. Triclosan-coated sutures and surgical site infection in abdominal surgery: the TRISTAN review, meta-analysis and trial sequential analysis. Hernia 21, 833–841 (2017). https://doi.org/10.1007/s10029-017-1681-0

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