*3.1. Clinical Results*

Nine meta-analyses were identified from database searching [28,29,33–39] (Table 2). After the critical appraisal of all publications, Henriksen et al. was selected as the latest meta-analysis that best matched the inclusion and exclusion criteria [28]. This meta-analysis included eight randomized trials that investigated the role of TCS in preventing SSIs in adult patients undergoing gastrointestinal surgery [20–27]. In the pooled analysis, the authors found a significant reduction of SSIs in the experimental group (SSI rate 10.1% for TCS versus 13.5% for CS; OR: 0.67; 95% CI: 0.46–0.98; *p* = 0.04). Another meta-analysis, with similar characteristics that included 10 RCTs, published in 2018, was not considered due to an input mistake in the forest plot analysis of the TCS effect in gastrointestinal surgery [29]. In particular, for Diener et al. [21], the authors considered 334 patients in the TCS arm versus 331 in the control arm instead of 587 and 598 patients, respectively, as reported in the original publication, thus resulting in an unreliable overall treatment OR.

The characteristics of the studies included in the Henriksen et al. meta-analysis are summarized in Table 3. The heterogeneity among the RCTs was high: four trials [20,23,26,27] encompassed only elective colorectal surgery, one [21] comprised all types of elective procedures through a midline laparotomy, another [22] included both elective and emergency laparotomies, another [24] evaluated only emergency surgery for fecal peritonitis, and the final study [25] analyzed only patients undergoing open appendectomy. The study sample size varied from 100 to 1185 patients; the role of laparoscopy was not clearly reported in the majority of studies.

Following publication of the above mentioned meta-analysis, two additional RCTs that investigated the role of TCS in abdominal surgery were identified [40,41]. Ichida et al. [41] evaluated 1013 adult patients undergoing both laparoscopic and open gastrointestinal operations; the authors declared full adherence to the WHO recommendations for SSI prevention. After a follow-up of 30 days, the study results showed no difference between the groups (6.9% in the TCS group versus 5.9% in the control group; *p* = 0.609). Furthermore, no significant differences within all subgroups were identified when comparing interventions for different target abdominal organs.

Olmez et al. [40] reported a RCT that investigated the effect of triclosan-coated monofilament polydioxanone (PDS) compared to standard PDS on SSI incidence after laparotomy for any type of gastrointestinal disease in 890 patients. The Consolidated Standards of Reporting Trials diagram of the randomization process and the concealment assignment were not available. The authors reported antibiotic prophylaxis as the only standard strategy for SSI prevention. Likewise, patients in the two study groups had significant differences in baseline characteristics (Body mass index, smoking habit, anemia, hypertension, and diabetes mellitus) that are potentially involved in SSI risk. The overall effect of TCS was a significant but untrustworthy reduction in the rate of SSI (19.1% vs. 25.8% in the TCS and CS groups, respectively; *p* = 0.016).



Abbreviations: CR, colorectal; CS, conventional sutures; NR, not reported; RCT, randomized controlled trial; TCS, Triclosan-coated sutures; RR, risk ratio; and OR, odds ratio. Surgeries were reported if analyzed in sub-analysis (for meta-analyses performing sub-analyses).


