Natural history of vertical abdominal parietal closure: Prolene versus Dexon

The long-term outcome of laparotomy incisions after mass closure (taking large tissue bites through all layers) with continuous polypropylene (Prolene) in 95 patients or interrupted polyglycolic acid (Dexon) sutures in 105 patients was compared by randomized prospective study. Of the 200 patients, 194 incisions were median and 2 were paramedian (4 patients were excluded). There was one wound dehiscence (0.51%) due to slippage of a polypropylene knot. At 5-year follow-up, 4 hernias were found in incisions repaired with polypropylene, compared with 11 in the polyglycolic acid group; 10 of the 11 occurred after the first year (p = 0.01). Wound infections were slightly more frequent in patients whose incision was closed with polypropylene. Only two hernias in each group occurred in patients who had had wound infections. Polypropylene and polyglycolic acid both allow rapid and secure closure of vertical laparotomy incisions, but late herniation is more common when polyglycolic acid sutures are used.