Layer Closure of Laparotomy Wounds: A Comparative Analysis Between Semi-Absorbable and Non-Absorbable Suture Material
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Background: Midline laparotomy closure remains a clinically important determinant of early postoperative wound morbidity, and the choice between delayed absorbable and non-absorbable monofilament sutures continues to influence surgical practice. Objective: To compare early postoperative outcomes of continuous mass fascial closure using polydioxanone versus polypropylene in patients undergoing elective or emergency midline laparotomy. Methods: This single-centre randomized comparative study was conducted at the Department of General Surgery, Combined Military Hospital Rawalpindi, from August to October 2024. Sixty-six patients aged 18–70 years undergoing midline laparotomy were allocated equally to polydioxanone or polypropylene fascial closure. Patients were followed for 30 days and assessed for wound infection, fascial dehiscence, suture sinus formation, day-14 postoperative pain using the Visual Analogue Scale, and hospital stay. Results: Baseline characteristics were comparable between groups. Wound infection occurred in 2/33 patients receiving polydioxanone and 6/33 receiving polypropylene, while fascial dehiscence occurred in 1/33 and 4/33 patients, respectively. Suture sinus formation was absent with polydioxanone but occurred in 4/33 polypropylene cases. Mean day-14 pain score was significantly lower with polydioxanone than polypropylene (3.21 ± 1.38 vs 4.73 ± 1.79; p<0.001), whereas hospital stay was comparable (5.06 ± 1.56 vs 5.42 ± 1.84 days). Conclusion: Polydioxanone provided comparable early wound security to polypropylene and was associated with lower observed suture-related morbidity and reduced day-14 postoperative pain
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