Comparison of Traditional Long Bite Polypropylene Versus Short Bite Polydioxanone Suture Closure of Midline Abdominal Wound in Emergency Laparotomy

Abstract

Background: The midline incision is the most common incision for abdominal access during emergency surgery. The current study is aimed to identify the best suture material for closing the abdominal wall following surgery between polydioxanone and polypropylene based on the length of hospital stay following surgery and the occurrence of incisional hernia. Methodology: This quasi-experimental study was conducted in the Department of Surgery of Faridpur Medical College and Hospital (FMCH), Faridpur, Bangladesh over a period of 24 months starting from January 2024 to December 2025. The patients were categorized into two groups: Group-A: Midline wound closed by polypropylene (Prolene) and Group-B: Midline wound closed by polydioxanone (PDS). A p-value <0.05 was considered statistically significant. Results: A total of 200 patients were after fulfilling the inclusion and exclusion criteria. There were 100 patients in each group. Perforation of gas containing hollow viscus (PGCHV) was the major cause of emergency admission who underwent laparotomy during the study period in both groups (32.5% vs. 30.0%). In-hospital mortality occurred in 14 patients (7.0% overall), with 10 deaths (5.0%) in the Prolene group and 4 deaths (2.0%) in the PDS group (p=0.113). There was statistically significant difference between two groups in terms of SSI which was more in Prolene group (35.5% vs.20.00%; RR-1.45; 95%CI:1.23-1.56); p=0.02). Besides, rate of incisional hernia was more in group-A (7%vs 1%) within 6 months which was statistically significant (RR: 2.18;95% CI:1.96-2.32, p=0.003). However, no significant difference was found in terms of re-operation rate and burst abdomen between two groups (p>0.05). Conclusion: The study has showed use of short bite polydioxanone suture has significantly reduced these complications in comparison to polypropylene. Further large scale randomized trial should be advocated to provide a better result to the patients.