Closure of abdominal midline fascia: Meta-analysis delineates the optimal technique

The current surgical literature has not clearly demonstrated an optimal tec hnique for abdominal closure. Prospective randomized studies published betw een 1980 and 1998 were analyzed and the relevant data derived from those st udies were pooled for statistical evaluation. The outcome variables of dehi scence, infection, hernia formation, suture sinus formation, and pain were studied and the probability of their occurrence in association with differe nt techniques was calculated. In relation to the outcome features of dehisc ence and infection no statistically significant difference was seen when ab sorbable suture material was compared with nonabsorbable material. In regar d to the probability of hernia formation no statistically significant diffe rence was seen when monofilament absorbable material was compared with nona bsorbable material. There was, however, a higher incidence of hernia format ion when braided absorbable suture material was used. In addition there was a higher incidence of incision pain and suture sinus formation when nonabs orbable suture material was used. Absorbable monofilament suture material i s superior to both absorbable braided and nonabsorbable suture for abdomina l fascial closure. A continuous mass (all-layer) closure with absorbable mo nofilament suture material is the optimal technique for fascial closure aft er laparotomy.