Published: 2021-12-28

Short term outcome of midline laparotomies in view abdominalfascia closer

Chinmay S. Gandhi, Dajiram G. Mote, Zahid Shivani, Kalyan Kumar Sama


Background: This is a prospective non randomized observational comparative study for surgical site infections and surgical site occurrences after laparotomy fascia closer with two different techniques. Regular bite remains the standard of care in most hospitals. Laparotomies were done for elective and emergency cases.

Methods: There were two techniques used to close abdominal wall fascia. The present study has evaluated small bite abdominal closer verses regular bite closer. Author and his team had used small bite fascia closer technique for all laparotomies, while other group of surgeons utilized regular bite fascia closer.

Results: Out of 26 laparotomies in short bite closer, 8 had surgical site infections and surgical site occurrences, while 26 laparotomies in regular bite closer group had 15 patients with surgical site infections and surgical site occurrences. There is significant reduction in surgical site infection and surgical site occurrences observed in small bite abdominal closer group.

Conclusions: It is recommended all laparotomies elective or emergent should be closed with small bite technique as it reduces surgical site infections and surgical site occurrences.


Laparotomy closer, Small bite closer, Regular bite closer, Surgical site infection, Surgical site occurrences

Full Text:



Fortelny RH. Abdominal wall closer in elective midline laparotomies, the current recommendations. Front Surg. 2018;5:34.

Deerenberg EB, Harlaar JJ, Steyerberg EW. Small bites versus large bites for closure of abdominal midline incisions (STITCH): a double-blind, multicentre, randomised controlled trial. Lancet. 2015;386(10000):1254-60.

Itatsu Y, Sugawara G. Incidence of and risk factors for incisional hernia after abdominal surgery. Brit J Surg. 2014;101(11):1439-47.

Murray BW, Daisha J. The impact of surgical site infection on the development of incisional hernia and small bowel obstruction in colorectal surgery. Am J Surg. 2011;202(5):558-60.

Chowdhury SK, Choudhury SD. Mass closure versus layer closure of abdominal wound: a prospective clinical study. J Indian Med Assoc. 1994;92(7):229-32.

Patel SV, Paskar DD, Nelson RL. Closure methods for laparotomy incisions for preventing incisional hernias and other wound complications. Cochrane Database Syst Rev. 2017;11(11):CD005661.

Cameron AE, Parker CJ, Field ES, Gray RC, Wyatt AP. A randomised comparison of polydioxanone (PDS) and polypropylene (Prolene) for abdominal wound closure. Ann R Coll Surg Engl. 1987;69(3):113-5.

Krukowski ZH, Cusick EL, Engeset J, Matheson NA. Polydioxanone or polypropylene for closure of midline abdominal incisions: a prospective comparative clinical trial. Br J Surg. 1987;74(9):828-30.

Israelsson LA, Jonsson T, Knutsson A. Suture technique and wound healing in midline laparotomy incisions. Eur J Surg. 1996;162(8):605-9.

Millbourn D, Israelsson LA. Wound complications and stitch length. Hernia. 2004;8(1):39-41.

Israelsson LA, Jonsson T. Suture length to wound length ratio and healing of midline laparotomy incisions. Br J Surg. 1993;80(10):1284-6.

de Vries HS, Verhaak T, van Boxtel TH, van den Heuvel W, Teixeira MB, Heisterkamp J, Zimmerman DDE. Implementation of the small bites closure of abdominal midline incisions in clinical practice is correlated with a reduction in surgical site infections. Hernia. 2020;24(4):839-43.

Tolstrup MB, Watt SK, Gögenur I. Reduced Rate of Dehiscence After Implementation of a Standardized Fascial Closure Technique in Patients Undergoing Emergency Laparotomy. Ann Surg. 2017;265(4):821-826.

Albertsmeier M, Hofmann A, Baumann P, Riedl S, Reisensohn C, Kewer JL, et al. Effects of the short-stitch technique for midline abdominal closure: short-term results from the randomised-controlled ESTOIH trial. Hernia. 2021.

Kushner BS, Arefanian S, McAllister J. Examination of abdominal wall perfusion using varying suture techniques for midline abdominal laparotomy closure. Surg Endosc. 2021.