Wound and skin infection also places patients at risk for incisional hernia. In one meta-analysis, it was found that the risk of hernia was higher when absorbable sutures were used and when the closure was layered, rather than mass. Another meta-analysis of lower abdominal incisions, published in 2000, confirms that nonabsorbable sutures reduced the relative risk of hernia. By extrapolation, the longer there is some control of the wound environment in the fascia, the more the risk of hernia is reduced. I don't know if we have come to a consensus, but in my mind, the delayed absorbable sutures are just as good as nonabsorbable sutures.
Suture placement is critical.
As we have said, sutures should not be placed too close to the edges of the fascia. Sutures should be handled as little as possible, and then with nothing but the hand and the glove. Finally, if you look at the literature in a critical fashion, there is really no difference in hernia rates with regard to transverse incisions, vertical incisions, and paramedian incisions. This program is sponsored by Johns Hopkins School of Medicine.