Ideal Suturing of abdominal wall
Ideal suturing technique should be
Fast
Easy
Cost effective
Prevents early and late complications
Early complications are
Wound dehiscence, Evisceration and Infection
Late complications are hernia, suture sinus and incisional pain.
Controversies
Layered abdominal wall closure Vs Mass closure
Layered closure
Reduces Intraperitoneal adhesions
Added to wound strength
Promoted Hemostasis
Brennan TG, Jones NAG, Gillou PJ. Lateral paramedian incision. Br J Surg. 1987;74:736-737.
Gilbert JM, Ellis H, Foweraker S. Peritoneal closure after lateral paramedian incision. Br J Surg. 1987;74:113-115.
Mass closure
Smead first described a mass closure technique in 1900
Jones described the same technique in 1941
Smead & Jones technique
Bucknall et al layered closure was associated with a significantly higher dehiscence rate compared with mass closure (3.81% vs. 0.76%)
Recently published meta-analyses have confirmed a statistically significant reduction in hernia formation and dehiscence with mass closure.
Weiland DE, Bay C, Del Sordi S. Choosing the best abdominal closure by meta-analysis. Am J Surg. 1998;176: 666-670.
Rucinski J, Margolis M, Panagopoulos G, Wise L. Closure of the abdominal midline fascia: meta-analysis delineates the optimal technique. Am Surg. 2001;67:421-426.
Conclusion - Mass abdominal suture closure is better than layered closure
Interrupted Vs Continuous suture
No difference in the incidence of dehiscence or hernia formation when either technique is used.
Fagniez P, Hay JM, Lacaine F, Thomsen C. Abdominalmidline incision closure. Arch Surg. 1985;120:1351-1353.
