Incisional hernia after laparotomy: Prospective randomized comparison between early-absorbable and late-absorbable suture materials

Incisional hernia is a serious postoperative complication of laparotomy. Se lecting an appropriate suture material may lessen such morbidity. This stud y undertook a prospective, randomized comparison of early-absorbable polygl actin 910 suture versus late-absorbable polydioxanone loop suture for Fasci al closure after abdominal surgery. A series of 340 consecutive patients un dergoing elective laparotomy were randomized to have fascial closure with e ither polyglactin 910 suture or polydioxanone loop suture between October 1 993 and August 1996. A 2-year follow-up revealed that 23 patients had died, and the overall mortality rate was 6.8% (23/340). Ten (10/340, 2.9%) patie nts, including seven with polyglactin 910 suture and three with polydioxano ne loop suture, developed incisional hernias. The early postoperative evalu ation revealed an incidence of wound infection of 4.1% (14/340). The develo pment of incisional hernia was not secondary to postoperative wound infecti on in this study. Among these 340 patients, 192 had malignant diseases and 148 had nonmalignant ones. Fascial closure with polyglactin 910 suture was associated with more incisional hernias than that with polydioxanone loop s uture, with marginal significance for patients in the malignant group (4.7% versus 0%, p = 0.07) but not in the nonmalignant group (2.6% versus 4.2%, p = 0.67). In conclusion, abdominal closure with a late-absorbable polydiox anone loop suture may be beneficial to patients with a malignant disease fo r preventing incisional hernia.