Timing of Fascial Closure After Damage Control Laparotomy for Trauma: A PRISMA 2020–Compliant Systematic Review and Evidence Synthesis

Background: Damage control laparotomy (DCL) is a life-saving strategy for critically injured trauma patients but is associated with significant morbidity when the abdomen remains open. Early definitive fascial closure is advocated; however, the optimal timing—particularly closure within 48 hours—remains controversial. Objective: To systematically review and synthesize available evidence evaluating the impact of fascial closure timing, specifically ≤48 hours versus >48 hours, on outcomes following DCL. Data Sources: PubMed/MEDLINE, PubMed Central (PMC), and Google Scholar. Study Eligibility Criteria: Peer-reviewed studies involving adult trauma patients undergoing DCL that reported outcomes related to timing of re-laparotomy or fascial closure. Results: Six studies met inclusion criteria for qualitative synthesis. No study directly compared definitive fascial closure ≤48 hours versus >48 hours as a primary exposure. Registry-based evidence consistently demonstrated that failure to achieve primary fascial closure during index hospitalization was associated with markedly increased mortality and enterocutaneous fistula formation (DuBose et al., 2013; Bradley et al., 2013). Earlier re-laparotomy (within 24–48 hours) predicted higher likelihood of successful closure (Pommerening et al., 2014). A recent systematic review and meta-analysis found that planned reoperation ≤48 hours increased re-bleeding risk without mortality benefit (Seo et al., 2025). Conclusions: Achieving definitive primary fascial closure is paramount. While early re-laparotomy facilitates closure, rigid adherence to a 48-hour rule for definitive closure is not supported by current evidence. Closure decisions should be physiology-guided. Prospective studies directly evaluating definitive closure timing are needed.