Gradually Absorbable Sutures Lower Long-Term Recurrence in Open Incisional Hernia Repair

Overview

This nationwide cohort study of 3,393 patients undergoing open incisional hernia mesh repair found that use of slowly absorbable sutures for fascial closure was associated with a significantly lower 5-year cumulative incidence of hernia recurrence compared to non-absorbable sutures. Slowly absorbable sutures also demonstrated comparable safety profiles regarding early postoperative complications.

Background

Incisional hernia development is influenced by multiple factors including patient biology and surgical technique. Fascial closure technique and suture material are critical, with guidelines recommending slowly absorbable sutures due to their biomechanical properties aligning with prolonged fascial healing. However, evidence specifically addressing suture type impact on recurrence after open mesh repair of incisional hernias has been limited. This study aimed to clarify whether suture type affects long-term hernia recurrence and early postoperative outcomes.

Data Highlights

Key Findings

• 5-year cumulative incidence of hernia recurrence was significantly lower with slowly absorbable sutures (6.3%) compared to non-absorbable sutures (8.3%) (P=0.006).
• Patients with recurrence were younger and more likely to have had non-absorbable sutures used for fascial closure.
• Mesh placement location differed between groups, with retromuscular placement more common in the slowly absorbable suture group.
• There was no significant difference in 90-day reoperation rates between suture types (4.1% vs. 4.3%, P=0.75).
• Multivariate analysis adjusting for confounders confirmed slowly absorbable sutures were independently associated with reduced recurrence risk.

Clinical Implications

Surgeons performing open incisional hernia mesh repair should preferentially use slowly absorbable sutures for fascial closure to reduce long-term hernia recurrence risk. This suture choice does not increase early postoperative complications and aligns with current biomechanical understanding of fascial healing. Adoption of slowly absorbable sutures may improve patient outcomes without compromising safety.

Conclusion

Use of slowly absorbable sutures for fascial closure in open incisional hernia mesh repair is associated with a lower long-term risk of hernia recurrence compared to non-absorbable sutures, supporting guideline recommendations and providing evidence for optimized surgical technique.

References

1. Israelsson 1993 -- Suture-to-wound length ratio and incisional hernia prevention
2. Guidelines for Hernia Repair 2020 -- Recommendations on suture materials
3. Danish Ventral Hernia Database 2022 -- Nationwide registry data
4. STROBE Statement 2007 -- Reporting observational studies