Closure of midline laparotomy incisions with polydioxanone and nylon: The importance of suture technique

Abstract

The healing of midline laparotomy incisions closed with a continuous suture of nylon or second-generation polydioxanone was evaluated in a randomized clinical trial. The effect of suture technique, reflected in the suture length to wound length ratio, was also assessed. All patients who underwent abdominal surgery through a midline incision were included except those with incisional hernia after previous midline operation. Wound dehiscence occurred in five (0.6 per cent) of 813 patients and wound infection in 73 (9.0 per cent). These rates were similar for both suture materials, as were those for the development of suture sinus and prolonged postoperative wound pain. Incisional hernia 12 months after surgery was found in 49 (15.1 per cent) of 325 wounds sutured with polydioxanone and in 50 (15.7 per cent) of 318 closed with nylon (P = 0.91). There was a significant correlation between the hernia rate and the suture to wound length ratio for both materials (P < 0.001). These results indicate that suture of midline laparotomy wounds is as safe with polydioxanone as it is with nylon. Incisional hernia is associated more with suture technique than with the material used.

Mass closure versus layered closure of midline laparotomy incisions: a prospective comparative study

“…[4][5][6] As compared to studies by Leaper DJ et al and Khan NA et al it is less and this may be because of small sample size in present study. 7,8 In the study conducted by Israelsson et al and Bloemen et al the incidence of wound infection is 9.4% and 7.7% respectively in mass closure group.…”

“…7,8 In the study conducted by Israelsson et al and Bloemen et al the incidence of wound infection is 9.4% and 7.7% respectively in mass closure group. 9,10 In present study wound infection rate in layered closure group is 6.66%, As compared to studies by Ellis H et al (5%) and Kendal et al study (5%) rate of infection in present study is higher. As compared to mass closure wound infection is higher in layered closure, it may be due to more tissue handling, more exposure of wound to atmosphere air.…”

An ideal suture for midline abdominal closure?

“…There was a very high incidence of wound dehiscence (n=5) in the PDS group, which has not been reported in any previously performed study [6,[11][12][13]15]. Individual patient profi le was recorded for the 5 patients with wound dehiscence (Table 2).…”

“…Numerous randomized controlled trials of abdominal fascial closure have failed to determine the ideal suture material with fi nality [11][12][13]. Certain meta-analyses [1,14] recommend the use of non absorbable sutures, where as others [4,5] advocate slowly absorbable suture material for abdominal fascial closure.…”

Comparative Study Between Continuous Suture and Interrupted Suture in Laparotomy Wound Repair

“…Different suture techniques are used for closure of laparotomy wounds and each has its own strong point. 4,5,6 However, the reliability of the existing evidence is compromised by the low number of relevant randomised controlled trials (RCTs). 7,8 Therefore, the discussion regarding the optimal technique of abdominal fascia experience rather than acting evidence-based.…”