title: Small stitches with small suture distances increase laparotomy closure strength.
abstract: BACKGROUND
  There is no conclusive evidence which size of suture stitches and suture distance should be used to prevent burst abdomen and incisional hernia.
  
  
  METHODS
  Thirty-eight porcine abdominal walls were removed immediately after death and divided into 2 groups: A and B (N = 19 each). Two suturing methods using double-loop polydioxanone were tested in 14-cm midline incisions: group A consisted of large stitches (1 cm) with a large suture distance (1 cm), and group B consisted of small stitches (.5 cm) with a small suture distance (.5 cm).
  
  
  RESULTS
  The geometric mean tensile force in group B was significantly higher than in group A (787 N vs 534 N; P = .006).
  
  
  CONCLUSIONS
  Small stitches with small suture distances achieve higher tensile forces than large stitches with large suture distances. Therefore, small stitches may be useful to prevent the development of a burst abdomen or an incisional hernia after midline incisions.
authors.affiliation: Department of General Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. j.harlaar@erasmusmc.nl
authors.forename: Joris J
authors.initials: JJ
authors.lastname: Harlaar
authors.forename: Gabrielle H
authors.initials: GH
authors.lastname: van Ramshorst
authors.forename: Jeroen
authors.initials: J
authors.lastname: Nieuwenhuizen
authors.forename: Joost G
authors.initials: JG
authors.lastname: Ten Brinke
authors.forename: Wim C J
authors.initials: WC
authors.lastname: Hop
authors.forename: Gert-Jan
authors.initials: GJ
authors.lastname: Kleinrensink
authors.forename: Hans
authors.initials: H
authors.lastname: Jeekel
authors.forename: Johan F
authors.initials: JF
authors.lastname: Lange
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000818:Animals; D006547:Hernia / Q000517:prevention & control*; D016687:Polydioxanone; D011183:Postoperative Complications / Q000517:prevention & control; D013529:Surgical Wound Dehiscence / Q000517:prevention & control*; D013536:Suture Techniques; D013552:Swine; D013718:Tensile Strength
chemical_list: D016687:Polydioxanone