Randomized clinical trial comparing polypropylene or polydioxanone for midline abdominal wall closure.

Area of Science:

• Surgical innovation
• Clinical research
• Abdominal surgery

Background:

• Incisional hernia is a common complication following abdominal surgery.
• Surgical intervention is often necessary for treatment.
• This study investigated suture materials for fascial closure.

Purpose of the Study:

• To compare the efficacy of non-absorbable polypropylene (Prolene®) versus absorbable polydioxanone (PDS®) suture materials in preventing incisional hernias.
• To assess secondary outcomes including surgical-site infection and suture sinus formation.

Main Methods:

• A prospective randomized trial involving 456 patients undergoing abdominal surgery.
• Fascial closure was performed using either Prolene® or PDS® sutures.
• Follow-up included clinical examination and ultrasonography at 6-month intervals.

Main Results:

• Incisional hernia incidence was 20.2% with Prolene® (n=223) and 24.9% with PDS® (n=233), a non-significant difference (P=0.229).
• Four-year cumulative hernia rates were 23.7% for Prolene® and 30.2% for PDS® (P=0.222).
• No significant differences were observed in secondary outcomes like surgical-site infection or suture sinus.

Conclusions:

• Both polypropylene (Prolene®) and polydioxanone (PDS®) sutures demonstrated comparable outcomes regarding incisional hernia formation.
• The incidence of incisional hernias observed in this trial exceeded expectations based on prior literature.
• Current evidence suggests no significant difference between these two suture materials for abdominal fascia closure.