ABSTRACT
OBJECTIVE: To evaluate the safety and efficacy of suture techniques for midline abdominal incisions with systematic review and meta-analysis. METHODS: The articles about suture techniques for midline abdominal incisions published from year of 1981 to 2009 in MedLine and Embase databases were retrieved. All the trials with a minimal follow-up of one year that randomized patients for midline laparotomy with different suture techniques and/or suture materials were subjected to meta-analysis. The outcomes included incisional hernia, wound dehiscence, wound infection and suture sinus formation. RESULTS: Total of 13 articles were collected in this analysis. Compared with continuous sutures, interrupted sutures had significantly more incisional hernias (OR = 0.80, 95%CI: 0.66 - 1.00;P = 0.05). Continuous rapidly absorbable suture was associated with significantly more incisional hernias than continuous slowly absorbable suture or continuous non-absorbable suture (15.8%, 10.0% and 8.3%, respectively; P < 0.05). More suture sinuses occurred in patients with continuous non-absorbable suture than in those with continuous rapidly absorbable suture (5.6% vs. 1.0%, P < 0.05); And more suture sinuses occurred in patients with interrupted non-absorbable suture than in those with interrupted rapidly absorbable suture (8.8% vs. 0, P < 0.05). Compared with continuous slowly absorbable suture, more suture sinuses occurred in patients with continuous non-absorbable suture (OR = 0.47, 95%CI: 0.24 - 0.92; P < 0.05). Less incisional hernias occurred in patients with a suture length/wound length ratio (SL/WL) of ≥ 4:1 than those with the ratio less than 4:1 (P < 0.05). CONCLUSION: To reduce the incidence of incisional hernia without increasing wound infection frequency, the ideal suture technique is mass closure using a continuous suture, with an adequate suture length/wound length ratio no less than 4:1, the suture materials should be slowly absorbable.
