Meta-analysis of techniques for closure of midline abdominal incisions

Br J Surg. 2002 Nov;89(11):1350-6. doi: 10.1046/j.1365-2168.2002.02258.x.


Background: Various randomized studies have evaluated techniques of abdominal fascia closure but controversy remains, leaving surgeons uncertain about the optimal method of preventing incisional hernia.

Method: Medline and Embase databases were searched. All trials with a follow-up of at least 1 year that randomized patients with midline laparotomies to closure of the fascia by different suture techniques and/or suture materials were subjected to meta-analysis. Primary outcome was incisional hernia; secondary outcomes were wound dehiscence, wound infection, wound pain and suture sinus formation.

Results: Fifteen studies were identified with a total of 6566 patients. Closure by continuous rapidly absorbable suture was followed by significantly more incisional hernias than closure by continuous slowly absorbable suture (P < 0.009) or non-absorbable suture (P = 0.001). No difference in incisional hernia incidence was found between slowly absorbable and non-absorbable sutures (P = 0.75), but more wound pain (P < 0.005) and more suture sinuses (P = 0.02) occurred after the use of non-absorbable suture. Similar outcomes were observed with continuous and interrupted sutures, but continuous sutures took less time to insert.

Conclusion: To reduce the incidence of incisional hernia without increasing wound pain or suture sinus frequency, slowly absorbable continuous sutures appear to be the optimal method of fascial closure.

Publication types

  • Meta-Analysis

MeSH terms

  • Hernia, Ventral / prevention & control*
  • Humans
  • Laparoscopy / methods*
  • Postoperative Complications / prevention & control
  • Prospective Studies
  • Randomized Controlled Trials as Topic
  • Surgical Wound Dehiscence / prevention & control
  • Suture Techniques / standards*
  • Sutures
  • Wound Healing