Evidence-Based Suture Techniques in Abdominal Wall Closure

Introduction to Suture Techniques

The World Society of Emergency Surgery recommends specific, evidence-based approaches for abdominal wall closure, including continuous suture technique, small bite technique, and mass closure 1, 2, 3, 4

The American College of Surgeons and the World Society of Emergency Surgery prefer continuous suture technique over interrupted sutures due to faster closure time, with no difference in hernia or dehiscence rates 4
The World Society of Emergency Surgery suggests using small bite technique (5mm from wound edge, 5mm between stitches) to reduce incisional hernia compared to large bite technique 1, 2
Mass closure (single layer including all fascial layers) is faster than layered closure with equivalent outcomes, as recommended by the World Society of Emergency Surgery 2, 4
The use of slowly absorbable monofilament sutures is recommended to reduce infection risk and maintain tensile strength, according to the World Society of Emergency Surgery 1, 2

Continuous subcuticular sutures reduce superficial wound dehiscence compared to interrupted sutures, as found by the World Journal of Emergency Surgery 5

Retention sutures may be considered only in high-risk patients with severe preoperative malnutrition, immunocompromised status, previous fascial defects, massive abdominal contamination, or increased tension in the incision, with only 68% panel agreement on avoiding their routine use, as stated by the World Society of Emergency Surgery 3
The World Society of Emergency Surgery found insufficient evidence to recommend routine use of retention sutures 3