OBJECTIVETo evaluate the safety and efficacy of suture techniques for midline abdominal incisions with systematic review and meta-analysis.

METHODSThe 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.

RESULTSTotal 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).

CONCLUSIONTo 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.