Abdominal closure

There have been considerable developments in abdominal closure over the past 30 years or so, and (happily for some of the poorer countries of the world) they have not largely involved undue expense. Indeed many of the developments are compatible with considerable cost-saving. I have changed over from the traditional (as it was then) method of multilayer closure with catgut to a one-layer method with monofilament nylon (often fishing nylon) in 1971. Since that time, despite a previous unhappy experience with the upper abdominal paramedian closure, I have not had a single 'burst abdomen' in any adult patients since making that change.