Closure of the Abdominal Midline Fascia: Meta-Analysis Delineates the Optimal Technique

TLDR

Current literature has not identified a clear optimal technique for abdominal fascial closure. The authors pooled data from prospective randomized studies (1980–1998) to evaluate the probabilities of dehiscence, infection, hernia, suture sinus, and pain across different closure techniques. Absorbable monofilament suture in a continuous all‑layer closure is superior, reducing hernia rates compared with braided absorbable and nonabsorbable sutures, while nonabsorbable sutures increase pain and suture sinus, and no suture type differs for dehiscence or infection.

Abstract

The current surgical literature has not clearly demonstrated an optimal technique for abdominal closure. Prospective randomized studies published between 1980 and 1998 were analyzed and the relevant data derived from those studies were pooled for statistical evaluation. The outcome variables of dehiscence, infection, hernia formation, suture sinus formation, and pain were studied and the probability of their occurrence in association with different techniques was calculated. In relation to the outcome features of dehiscence and infection no statistically significant difference was seen when absorbable suture material was compared with nonabsorbable material. In regard to the probability of hernia formation no statistically significant difference was seen when monofilament absorbable material was compared with nonabsorbable material. There was, however, a higher incidence of hernia formation when braided absorbable suture material was used. In addition there was a higher incidence of incision pain and suture sinus formation when nonabsorbable suture material was used. Absorbable monofilament suture material is superior to both absorbable braided and nonabsorbable suture for abdominal fascial closure. A continuous mass (all-layer) closure with absorbable monofilament suture material is the optimal technique for fascial closure after laparotomy.