Choosing the best abdominal closure by meta analysis

BACKGROUND: Local custom, rather than evidence-based medicine, dictates how a surgeon closes abdominal wounds. Closures might be more secure if ground ed on statistical data. MATERIALS AND METHODS: A meta-analysis of 12,249 patients with abdominal wo und closures was made. Infections, hernias, and dehiscences were compared e xamining continuous versus interrupted closures, continuous (absorbable ver sus nonabsorbable), interrupted (absorbable versus nonabsorbable), and mass versus layered. RESULTS: Continuous absorbable closures showed more hernias (P = 0.0007), D ehiscences were significantly more with continuous nonabsorbable suture (P = 0.01), Interrupted nonabsorbable closures showed a higher incidence of he rnias and dehiscences (P = 0.002, P = 0.04), Mass closures produced signifi cantly less hernias and dehiscences when compared with layered closures (P = 0.02, P = 0.0002), CONCLUSIONS: Continuous closures with nonabsorbable suture should be used t o close most abdominal wounds, However, if infection or distention is antic ipated, interrupted absorbable sutures are preferred. Mass closures are sup erior to layered closures. Am J Surg. 1998;176:666-670, (C) 1998 by Excerpt a Medica, Inc.