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.