After a comprehensive search of electronic databases, five studies were included [5,6,7,8,9], encompassing 403 patients with different hospital admission causes (Appendix 2 in SI). In all studies, non-absorbable sutures were used. The summary of these studies is represented in Table 1. Additionally, (Appendix 3 in SI) shows the detailed PRISMA flow diagram. The overall risk of bias was low as from three RCTs, all domains were assigned to be low risk of bias, and the two OS were of good quality (Appendix 4 in SI).

In comparison to continuous sutures, MSJ showed a significant reduction in wound dehiscence (RR = 0.29, 95% CI [0.14–0.59], p = 0.0006). Conversely, the SJ subgroup showed no statistically significant difference, with increased risk in wound dehiscence (RR = 1.45, 95% CI [0.51–4.07], p = 0.49). The overall analysis, with a total of 403 patients, showed a significant reduction in both techniques (RR = 0.38, 95% CI [0.15–0.99], p = 0.05]. However, substantial heterogeneity was observed and resolved by the sensitivity analysis by excluding Garg et al. [6]. The results consistently supported the strength of the findings, demonstrating a significant decrease in the risk of wound dehiscence (Fig. 1A).

Meta-analysis results of wound-related complications and hospital stay. (A) Wound dehiscence: Risk ratio (RR) with 95% confidence interval (CI). (B) Wound infection: RR with 95% CI. (C) Incisional hernia: RR with 95% CI. (D) Hospital stay: Mean difference (MD) with 95% CI

MSJ showed a significant reduction in wound infection (RR = 0.41, 95% CI [0.26–0.65], p = 0.0002). Conversely, the SJ subgroup analysis showed the opposite (RR = 1.03, 95% CI [0.50–2.13], p = 0.93). The overall analysis showed a significant reduction in wound infections (RR = 0.55, 95% CI [0.30–1.01], p = 0.05), with moderate heterogeneity. A sensitivity analysis was conducted by excluding Garg et al. [6]. The results consistently supported the strength of the findings, demonstrating a significant decrease in the risk of wound infection (Fig. 1B).

Both subgroups, MSJ and SJ, showed no significant difference in incisional hernia risk (RR = 0.17, 95% CI [0.02–1.33], p = 0.09) and (RR = 5.16, 95% CI [0.26–103.27], p = 0.28), respectively. Similarly, the overall analysis did not show any significant difference (RR = 0.78, 95% CI [0.03–22.12], p = 0.88). There was substantial heterogeneity, and sensitivity analysis was conducted by excluding Garg et al. [6], which maintained non-significant results (Fig. 1C).

The analysis showed no significant difference in hospital stay between MSJ and continuous (MD = – 1.21, 95% CI [– 7.67, 5.26], p = 0.71). Considerable heterogeneity was observed, and sensitivity analysis was conducted by excluding Sringeri et al. [9], demonstrating a significant reduction in hospital stay with MSJ.