For an elective midline laparotomy, a small-bites technique with a slowly absorbable monofilament suture lowers the rate of incisional hernia compared with large bites. Take bites about 5 mm from the wound edge and 5 mm apart, through the aponeurosis only.
Aim for a suture length at least four times the wound length. It is cheap, needs no mesh, and is the baseline on which any prophylactic mesh decision sits.
- Use a slowly absorbable monofilament suture for midline fascial closure.
- Place bites about 5 mm from the edge and 5 mm apart.
- Check the suture-to-wound length ratio is at least 4 to 1.
- Avoid including fat and muscle in the bite.
Why it matters
Technique, not just material, decides how many patients come back with a hernia.
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