Continuous double loop closure: a new technique for repair of laparotomy wounds.

Abstract

Wound dehiscence after midline laparotomy is a life threatening complication, most frequently caused by sutures cutting through the fascia. Increasing the strength of the sutured wound could prevent wound rupture. In an experimental study in the rat, the simple continuous suture (SCS), loop suture (LS), interrupted double loop closure and continuous double loop closure (CDLC) techniques were evaluated. Dehiscence pressure and volume were measured after closing a standard laparotomy. Laparotomies closed with the newly developed CDLC technique could withstand by far the highest intra-abdominal pressure before dehiscence (P < 0.0002). Wounds closed with this technique remained well approximated regardless of the intra-abdominal pressure, unlike wounds closed with the frequently used SCS and LS methods. In all animals sutured with the CDLC technique the intact abdominal wall ruptured lateral to the wound at dehiscence pressure, indicating that the bursting strength of the sutured wound was higher than that of the intact abdominal wall.