Small stitches with small suture distances increase laparotomy closure strength

Am J Surg. 2009 Sep;198(3):392-5. doi: 10.1016/j.amjsurg.2008.10.018. Epub 2009 Mar 12.


Background: There is no conclusive evidence which size of suture stitches and suture distance should be used to prevent burst abdomen and incisional hernia.

Methods: Thirty-eight porcine abdominal walls were removed immediately after death and divided into 2 groups: A and B (N = 19 each). Two suturing methods using double-loop polydioxanone were tested in 14-cm midline incisions: group A consisted of large stitches (1 cm) with a large suture distance (1 cm), and group B consisted of small stitches (.5 cm) with a small suture distance (.5 cm).

Results: The geometric mean tensile force in group B was significantly higher than in group A (787 N vs 534 N; P = .006).

Conclusions: Small stitches with small suture distances achieve higher tensile forces than large stitches with large suture distances. Therefore, small stitches may be useful to prevent the development of a burst abdomen or an incisional hernia after midline incisions.

MeSH terms

  • Abdominal Wall / surgery*
  • Animals
  • Hernia / prevention & control*
  • Polydioxanone
  • Postoperative Complications / prevention & control
  • Surgical Wound Dehiscence / prevention & control*
  • Suture Techniques*
  • Swine
  • Tensile Strength


  • Polydioxanone