Prophylactic Incisional Negative-Pressure Wound Therapy Versus Conventional Dressings in Emergency Colorectal Surgery: A Systematic Review of Randomized Controlled Trials

Choosing between prophylactic closed-incision negative pressure therapy and conventional sterile dressings remains a complex clinical challenge in emergency abdominal and acute colorectal surgery, where high contamination classes and physiological instability create severe vulnerabilities to incisional breakdown.This study compares how closed-incision negative pressure therapy and standard wound management perform against each other in emergency laparotomies and acute colorectal operations, focusing on primary 30-day surgical site infection rates, secondary abdominal wall complications, adverse safety profiles, and patient-reported outcomes.The literature search covered PubMed/MEDLINE, Scopus, SciELO (Scientific Electronic Library Online), LILACS (Latin America and the Caribbean Literature on Health Sciences), and CENTRAL (Cochrane Central Register of Controlled Trials) up to 2026, targeting prospective randomized controlled trials (RCTs) published between 2021 and 2026 evaluating prophylactic interventions against conventional dressings in adult emergency cohorts, with quality assessment relying on the Cochrane Risk of Bias 2 tool.Five prospective RCTs enrolling 1,221 patients qualified for qualitative analysis.Individual trials displayed distinct outcomes: smaller prospective studies reported notable reductions in superficial infections, whereas the large-scale pragmatic SUNRRISE trial (Single Use Negative pRessure dressing for Reduction In Surgical site infection following Emergency laparotomy) found no statistically significant difference in primary infection rates between groups.Secondary endpoints indicated selective mechanical benefits, such as reduced superficial dehiscence and lower day 7 pain scores, while hospital stay and mortality remained comparable.Prophylactic negative pressure exhibited good local device tolerance, with adverse events restricted to minor cutaneous reactions that resolved spontaneously.Substantial clinical and technical heterogeneity precluded formal quantitative meta-analysis pooling.Ultimately, prophylactic closed-incision negative-pressure therapy does not consistently eliminate primary infection rates across all high-risk emergency cohorts.However, it offers a favorable safety profile and advantages in early patientreported recovery, warranting further standardized trials to define optimal application parameters and patient selection.