{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T07:39:42Z","timestamp":1792136382527,"version":"4.4.0"},"reference-count":22,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T00:00:00Z","timestamp":1768348800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T00:00:00Z","timestamp":1768348800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The reinforced tension\u2010line suture (RTLS) technique distributes mechanical stress more evenly than traditional closure when closing a laparotomy wound, potentially reducing incisional hernia (IH) risk. We aimed to compare outcomes of RTLS versus standard closure techniques in patients undergoing laparotomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Systematic search of PubMed, MEDLINE, Web of Science, and bibliographic reference lists was conducted (last search: 26 January 2025). The protocol was registered with PROSPERO. Comparative studies reporting outcomes of RTLS versus other closure methods were included and their risk of bias was assessed. IH, Clavien\u2010Dindo (C\u2010D)\u2009\u2265\u2009III complications, wound dehiscence, wound infection, and procedure time were the evaluated outcome measures. Odds ratios (OR) for dichotomous outcomes and mean differences (MD) for continuous variables were determined. Heterogeneity was assessed using I\n                      <jats:sup>2<\/jats:sup>\n                      and Cochran's\n                      <jats:italic>Q<\/jats:italic>\n                      test.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Five comparative studies (four randomised and one observational) enrolling 708 patients who had their laparotomy wound closed using RTLS (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009393) or standard closure (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009315) were included. Use of RTLS significantly reduced risk of IH compared to standard technique (5.6% vs. 18.1%, OR 0.24; 95% CI: 0.15\u20130.38;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005). However, no significant differences were found in C\u2010D\u2009\u2265\u2009III complications (10.2% vs. 3.2%, OR 0.81; 95% CI: 0.18\u20133.54,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.62), wound dehiscence (2.3% vs. 6.9%, OR 0.34; 95% CI: 0.06\u20131.84,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.62), wound infection (9.0% and 10.4%, OR 0.34; 95% CI: 0.06\u20131.84,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.62) or procedure time (MD 23.50; 95% CI: \u221259.88\u2013106.87,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.16) between two groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>RTLS seems to significantly reduce IH incidence after laparotomy without increasing post\u2010operative morbidities or procedure time. Further Level 1 evidence is needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ans.70439","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T10:34:42Z","timestamp":1768386882000},"page":"759-771","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparative Outcomes of Reinforced Tension\u2010Line Sutures Versus Standard Closure Techniques in Patients Undergoing Laparotomy: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"96","author":[{"given":"Rama H. G.","family":"Mikhail","sequence":"first","affiliation":[{"name":"Hepato\u2010Pancreatico\u2010Biliary and General Surgery Unit Northern Health  Epping Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahin","family":"Hajibandeh","sequence":"additional","affiliation":[{"name":"Hepatobiliary and Pancreatic Surgery and Liver Transplant Unit Queen Elizabeth Hospital Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahab","family":"Hajibandeh","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary and Pancreatic Surgery Manchester Royal Infirmary Hospital  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marty","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of HPB Surgery Alfred Health  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ee Jun","family":"Ban","sequence":"additional","affiliation":[{"name":"Department of HPB Surgery Alfred Health  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8757-7122","authenticated-orcid":false,"given":"Rodney","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Department of HPB Surgery Alfred Health  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siobhan C.","family":"McKay","sequence":"additional","affiliation":[{"name":"Hepato\u2010Pancreatico\u2010Biliary and General Surgery Unit Northern Health  Epping Victoria Australia"},{"name":"Department of HPB Surgery Alfred Health  Melbourne Australia"},{"name":"Institute of Cancer and Genomic Science University of Birmingham  Birmingham 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