Single-Layer Mass Closure of Major Laparotomies by Continuous Suturing

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Abstract
Surgeons who close major laparotomy incisions in a single layer (excluding skin) usually put interrupted sutures of non-absorbable monofilament material. In 305 consecutive patients we have, instead, used continuous deep-bite mass sutures with satisfactory results. The suture material, chosen at random, was either monofilament nylon, monofilament stainless steel wire or polyglycolic acid (PGA). The length of material used was measured, and this figure divided by the number of bites to give the mean distance from the cut edges at which the needle had been inserted. The ratio of length of suture material to number of bites ranged from 3-10 em (mean 5.90, s.d.I.46). There were no burst abdomens, but 26 incisonal hernias were detected within six months of operation; these were significantly associated with male sex, old age, long incisions, long operations, postoperative coughing and distension, blood transfusion and wound sepsis. Steel sutures were removed from 5 patients because of pain or sinuses, and nylon sutures from one. We conclude that laparotomy closure by a single continuous layer of sutures is satisfactory, and that there is little to choose among nylon, PGA and steel. The incidence of incisional hernias would be reduced by the elimination of wound sepsis.