So, everything went well, and it is time now to close the abdomen. What an issue? Piece of cake. Is it so? Abdominal incisions are followed by an incisional hernia at a rate of about  12.6 per cent at 1 year to 22.4 per cent 3 years after surgery. So, let me ask you again: do you know which is the proper way of closing a midline abdominal incision? 

Traditionally, the 1×1 Jenkins rule (1 cm bite and 1 cm apart) has been considered the proper way. Nevertheless, recent data present a different option, mainly regarding the suture length and the bite size. Based on the European Hernia Society guidelines on the closure of abdominal wall incisions (Muysoms FE et al, Hernia, 2015), these are the rules for the proper abdominal closure today:

One layer only (aponeurosis). There is no need to close the peritoneum.

Use of small bites. 5 mm wide x 5 mm apart

Small needle: smaller needles mean smaller bites

Non-absorbable or slow absorbable suture, on a running fashion

Length of suture to length of wound: (at least) 4:1. The length of the suture must be at least 4 times the length of the wound.

You can have a look also in the following videos.

By the way, on 2 min 35 sec of the previous video, you can see a nice way to make the first knot.

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