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The following is a summary of “Role of wound protectors in preventing surgical site infection in patients undergoing abdominal surgery: a meta-analysis of randomized controlled trials,” published in the February 2025 issue of the BMC Surgery by Liu et al.

Surgical site infections (SSIs) remain a persistent global healthcare challenge despite longstanding efforts to achieve their complete eradication. Wound protectors (WPs) have been proposed as an effective intervention to prevent bacterial contamination of surgical incisions, yet conflicting evidence exists regarding their efficacy. This meta-analysis evaluates the impact of WPs on SSI rates among patients undergoing abdominal surgery, with a specific focus on different surgical sites and degrees of wound contamination. The risk of bias in each included study was assessed using the Cochrane Risk of Bias 2 tool, and trial sequential analysis was performed to account for the potential risks of random errors from repeated significance testing. Additionally, the quality of evidence was graded using the GRADEpro Guideline Development Tool. A total of 19 RCTs encompassing 4,779 participants met the inclusion criteria. 

Pooled analysis revealed that the use of WPs during abdominal surgery significantly reduced the overall SSI rate (RR = 0.63, 95% CI: 0.50–0.80, P = 0.0001), although the certainty of the evidence was rated as very low. Subgroup analysis indicated that WP implementation was particularly effective in reducing SSI rates following colorectal surgery (RR = 0.58, 95% CI: 0.38–0.91, P = 0.02, very low certainty evidence) and gastrointestinal surgery (RR = 0.49, 95% CI: 0.36–0.67, P < 0.00001, moderate certainty evidence). However, no clear protective benefit was observed for other types of abdominal procedures. Furthermore, WP use significantly decreased SSI rates in patients with clean-contaminated wounds (RR = 0.64, 95% CI: 0.46–0.89, P = 0.008, very low certainty evidence) and contaminated or dirty wounds (RR = 0.61, 95% CI: 0.41–0.92, P = 0.02, moderate certainty evidence). 

These findings suggest that while WPs can be an effective strategy for reducing SSI risk in select surgical populations, their routine use across all abdominal surgeries is not warranted. Instead, their application should be prioritized for gastrointestinal surgeries and cases involving contaminated or dirty wounds. Further research is needed to clarify the role of WPs in laparoscopic procedures and to strengthen the existing evidence base for their efficacy in various surgical contexts.

Source: bmcsurg.biomedcentral.com/articles/10.1186/s12893-025-02809-9