Early (≤7-Day) Definitive Fascial Closure After Open Abdomen Reduces Long-Term Morbidity: A Systematic Review and Meta-analysis

Background: Open abdomen (OA) management remains a life-saving strategy in trauma, intra-abdominal sepsis, and abdominal compartment syndrome. Failure to achieve definitive fascial closure (DFC) during the index hospitalization is strongly associated with long-term morbidity, particularly incisional hernia and entero-atmospheric fistula (EAF). While early closure has been associated with higher primary closure rates, its impact on durable, patient-centered outcomes has not been consistently evaluated. Objective: To determine whether early (≤ 7 days) versus delayed definitive fascial closure after open abdomen management is associated with differences in long-term morbidity and clinically relevant secondary outcomes. Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines. MEDLINE, Embase, Scopus, Web of Science, and Cochrane CENTRAL were searched from inception to January 2026. Comparative studies involving adult patients undergoing OA management were included. Primary outcomes were long-term incisional hernia and EAF/ECF. Random-effects meta-analysis was performed, with predefined subgroup and sensitivity analyses. Results: Nine studies encompassing 1,842 patients were included. Early closure was associated with a significantly lower risk of incisional hernia (18.6% vs 34.9%; RR 0.56, 95% CI 0.44–0.71) and EAF (6.2% vs 11.8%; RR 0.53, 95% CI 0.35–0.81). Early closure also increased the likelihood of primary fascial closure (RR 1.42, 95% CI 1.25–1.61) without increasing short-term mortality. Conclusion: Definitive fascial closure within ≤ 7 days after open abdomen management is associated with substantially improved long-term abdominal wall outcomes without compromising survival. Early closure should be considered a key therapeutic target in contemporary OA management.