• Joris J Harlaar, Gabrielle H van Ramshorst, Jeroen Nieuwenhuizen, Joost G Ten Brinke, Wim C J Hop, Gert-Jan Kleinrensink, Hans Jeekel, and Johan F Lange.
• Department of General Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. j.harlaar@erasmusmc.nl
• Am. J. Surg. 2009 Sep 1;198(3):392-5.

BackgroundThere is no conclusive evidence which size of suture stitches and suture distance should be used to prevent burst abdomen and incisional hernia.MethodsThirty-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).ResultsThe geometric mean tensile force in group B was significantly higher than in group A (787 N vs 534 N; P = .006).ConclusionsSmall 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.

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