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.

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The American Journal of Surgery
Erasmus MC: University Medical Center Rotterdam

Harlaar, J. J., van Ramshorst, G., Nieuwenhuizen, J., ten Brinke, J., Hop, W., Kleinrensink, G. J., … Lange, J. (2009). Small stitches with small suture distances increase laparotomy closure strength. The American Journal of Surgery, 198(3), 392–395. doi:10.1016/j.amjsurg.2008.10.018