Outcomes of the Herringbone Suturing Technique for the Closure of Anterior Abdominal Wall Surgeries: A Prospective...

Background Anterior abdominal wall closure following midline laparotomy plays a crucial role in determining postoperative outcomes. Complications such as surgical site infection, wound dehiscence, and incisional hernia continue to contribute significantly to postoperative morbidity, particularly in emergency surgical settings. Conventional closure techniques may not always provide uniform tension distribution across the vertically divided linea alba. The herringbone suturing technique, characterized by a continuous crisscross pattern, has been proposed to enhance tensile strength and wound stability. This study aimed to evaluate the effectiveness and outcomes of the herringbone suturing technique for anterior abdominal wall closure following midline laparotomy. Methodology This prospective observational study was conducted in the Department of General Surgery at M.G.M. Medical College and M.Y. Hospital, Indore. A total of 88 patients aged 18-60 years undergoing midline laparotomy were included over a six-month period, with an additional six-month follow-up. Abdominal wall closure was performed using a single-layer continuous herringbone suturing technique with loop PDS-1 sutures. Primary outcome measures included postoperative complications such as surgical site infection, wound dehiscence, fascial dehiscence, and burst abdomen. Secondary outcomes included the incidence of incisional hernia, postoperative pain assessed using the Visual Analog Scale, length of hospital stay, and time to return to routine activities. Statistical analysis was performed using SPSS version 25, with a p-value <0.05 considered statistically significant. Results An uncomplicated postoperative course was observed in 78 (88.6%) patients. The overall postoperative complication rate was 11.4%. Surgical site infection was the most common complication, occurring in 10 (11.4%) patients, predominantly superficial and detected within the first 14 postoperative days. Superficial wound dehiscence occurred in seven (8.0%) patients, while fascial dehiscence was noted in three (3.4%) patients. No cases of burst abdomen were recorded. An incisional hernia was observed in one (1.1%) patient during the six-month follow-up. No significant association was found between postoperative complications and age, sex, type of surgery, or preoperative diagnosis. Conclusions The herringbone suturing technique appears to be a safe and effective method for anterior abdominal wall closure following midline laparotomy, with low rates of early and late postoperative complications. Its consistent performance in both emergency and elective settings suggests that it may serve as a reliable alternative to conventional closure techniques. Further multicentric studies with larger sample sizes and longer follow-up are recommended to confirm these findings.