A study to evaluate the effects of various abdominal closure techniques on midline laparotomy wounds in a tertiary care hospital in West Bengal


  • Subuddha Chatterjee Department of General Surgery, Medical College Kolkata, West Bengal, India
  • Tunisha Bhattacharya Department of Paediatrics, Rampurhat Govt Medical College, Birbhum, West Bengal, India




Laparotomy, Short stitch, Long stitch, Surgical site infection, Wound dehiscence, Incisional hernia


Background: Post-operative complications of wound repair after laparotomy pose a major threat to life as well as to the health economy of a developing nation. Among many other factors, the length of suture used during wound closure has been studied for long. A prospective randomized control study comprising of 104 patients was conducted in the department of surgery of Bankura Sammilani medical college for comparing the incidence of SSI, wound dehiscence and incisional hernia after using short stitch and long stitch for repairing midline laparotomy wounds.

Methods: Out of 104 patients enrolled in the study, 51 patients were randomly allocated to short stitch group (suture length: wound length>4:1) and 53 patients were allocated to long stitch group (suture length: wound length=4:1) and both the groups were subsequently followed up for development of the three complications.

Results: Data analysis revealed that 11.7 % patients in short stitch group developed SSI whereas 24.5% patients in long stitch group developed SSI. Wound dehiscence occurred in 5.8 % of patients in short stitch group against 15% in long stitch group. 7.8% patients in short stitch group developed incisional hernia against 20.7% patients in long stitch group. In all three situations, p value was significant (<0.05).

Conclusions: It is concluded from our study that, the rate of SSI, wound dehiscence and incisional hernia is significantly lower in midline abdominal wounds closed with short stitch length than those closed with long stitch length.


Bevis PM, Windhaber RA, Lear PA, Poskitt KR, Earnshaw JJ, Mitchell DC. Randomized clinical trial of mesh versus sutured wound closure after open abdominal aortic aneurysm surgery. Br J Surg. 2010;97:1497-502.

Bloemen A, Van Dooren P, Huizinga BF, Hoofwijk AG. Randomized clinical trial comparing polypropylene or polydioxanone for midline abdominal wall closure. Br J Surg. 2011;98:633-9.

Diener MK, Voss S, Jensen K, Buchler MW, Seiler CM. Elective midline laparotomy closure: the INLINE systematic review and meta-analysis. Ann Surg. 2010;251:843-56.

Fink C, Baumann P, Wente MN. Incisional hernia rate 3 years after midline laparotomy. Br J Surg. 2014;101:51-4.

Van Ramshorst GH, Eker HH, Hop WC, Jeekel J, Lange JF. Impact of incisional hernia on health-related quality of life and body image: a prospective cohort study. Am J Surg. 2012;204:144-50.

Nieuwenhuizen J, Van Ramshorst GH, Ten Brinke JG. The use of mesh in acute hernia: frequency and outcome in 99 cases. Hernia. 2011;15:297-300.

Van ‘t Riet M, Steyerberg EW, Nellensteyn J, Bonjer HJ, Jeekel J. Meta-analysis of techniques for closure of midline abdominal incisions. Br J Surg. 2002;89:1350-6.

Muysoms FE, Antoniou SA, Bury K, Campanelli G, Conze J, Cuccurullo D. European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia. 2015;386:1254.

Millbourn D, Cengiz Y, Israelsson LA. Effect of stitch length on wound complications after closure of midline incisions: a randomized controlled trial. Arch Surg. 2009;144:1056-9.

Jenkins TP. The burst abdominal wound: a mechanical approach. Br J Surg. 1976;63:873-6.

DesCoteaux JG, Temple WJ, Huchcroft SA, Frank CB, Shrive NG. Linea alba closure: determination of ideal distance between sutures. J Invest Surg. 1993;6:201-9.

Karegoudar Jyothi S, Prabhakar PJ, Patil R. Effects of stitch length on wound complications following midline incision closure. New Indian J Surg. 2013;1:5-10.






Original Research Articles