Fifteen studies (6,566 patients) were included in the review.
Continuous closure using rapidly absorbable versus non-absorbable sutures (1 RCT, n=751): rapidly absorbable sutures resulted in significantly more incisional hernias (P=0.001) than non-absorbable suture, but less suture sinuses (P<0.001) and prolonged wound pain (P=0.003). There was no statistically-significant difference between the two suture types for any other outcome measure.
Continuous closure using slowly absorbable versus non-absorbable sutures (5 RCTs, n=2,669): non-absorbable sutures resulted in significantly more wound pain (P<0.005) and suture sinuses (P<0.02) than slowly absorbable sutures. There was no statistically-significant difference between the two suture types for the incidence of hernias, wound dehiscence, or wound infection.
Continuous closure using rapidly versus slowly absorbable sutures (1 RCT, n=749): rapidly absorbable sutures resulted in significantly more hernias (P<0.009) than slowly absorbable sutures. There was no statistically-significant difference between the two suture types for any other outcome measure.
Interrupted closure using rapidly absorbable versus non-absorbable sutures (1 RCT, n=161): there were significantly more suture sinuses (P<0.05) with non-absorbable than rapidly absorbable sutures. There was no statistically-significant difference between the two suture types for the incidence of hernias, wound dehiscence, or wound infection.
Interrupted versus continuous closure using rapidly absorbable sutures (1 RCT, n=744): there was no statistically-significant difference between the groups for any of the outcome measures.
Interrupted rapidly absorbable versus continuous non-absorbable (2 RCTs, n=1,210): the continuous non-absorbable suture method resulted in more suture sinuses (P=0.001) and wound pain (P<0.001) than the interrupted rapidly absorbable suture method. There was no statistically-significant difference between the groups for any other outcome measure.
Interrupted rapidly absorbable versus continuous slowly absorbable (4 RCTs, n=1,992): there was no statistically-significant difference between the groups for any of the outcome measures.
Interrupted non-absorbable versus continuous rapidly absorbable (1 RCT, n=105): there was no statistically-significant difference between the groups for the incidence of hernias, wound dehiscence, or wound infection.
Continuous versus interrupted (any suture type): the pooled analysis did not show any significant difference between the two techniques for incisional hernias (odds ratio 0.9, 95% confidence interval: 0.6, 1.2, P=0.40), or the incidence of wound dehiscence or wound infection (no results presented).
Analysis of the suture length to wound length ratio (3 RCTs): two studies reported that an increased suture length to wound length ratio of 4:1 or even 6:1 resulted in a significant decrease in the incidence of incisional hernia.