***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To compare the incidence of burst abdomen and incisional hernia after three different techniques of closure of the abdominal wall after major gastrointestinal operations . DESIGN Prospect i ve , r and omised , controlled trial . SETTING University hospital , Norway . SUBJECTS 599 adults who underwent major operations for gastrointestinal conditions between December 1990 and February 1992 . INTERVENTIONS Patients were r and omised in three groups for abdominal wall closure by continuous mass polyglyconate ( Maxon ) double suture with loop , continuous mass polyglactin 910 ( Vicryl ) , and interrupted polyglactin 910 ( Vicryl ) ( layered for transverse and mass for midline incisions ) . MAIN OUTCOME MEASURES Burst abdomen during the postoperative period , and incisional hernia after one year follow up . RESULTS The incidence of wound dehiscence was 2 % and of incisional hernia at one year 7 % . There were no differences in the rate of dehiscence among the groups , but there were significantly more hernias in the polyglyconate group ( 19/164 , 12 % ) compared with the two in which polyglactin 910 was used ( 16/327 , 5 % ) . Wound infections developed in 84/583 of our patients ( 14 % ) and the incidence was closely associated with emergency operations and contamination . Wound complications were not associated with the closure technique . CONCLUSIONS Wound infection is the most important single factor in the development of burst abdomen and incisional hernia . The continuous closure technique is quicker , cheaper , and as safe as the interrupted technique Background The optimal strategy for abdominal wall closure has been an issue of ongoing debate . Available studies do not specifically enroll patients who undergo emergency laparotomy  and thus do not consider the distinct biological characteristics of these patients . The present r and omized controlled trial evaluates the efficacy and safety of two commonly applied abdominal wall closure strategies in patients undergoing primary emergency midline laparotomy . Methods / design The CONTINT trial is a multicenter , open label , r and omized controlled trial with a two-group parallel design . Patients undergoing a primary emergency midline laparotomy are enrolled in the trial . The two most commonly applied strategies of abdominal wall closure after midline laparotomy are compared : the continuous , all-layer suture technique using slowly absorbable monofilament material ( two Monoplus ® loops ) and the interrupted suture technique using rapidly absorbable braided material ( Vicryl ® sutures ) . The primary endpoint within the CONTINT trial is an incisional hernia within 12 months or a burst abdomen within 30 days after surgery . As reliable data on this primary endpoint is not available for patients undergoing emergency surgery , an adaptive interim analysis will be conducted after the inclusion of 80 patients , allowing early termination of the trial if necessary or modification of design characteristics such as recalculation of sample size . Discussion This is a r and omized controlled multicenter trial with a two-group parallel design to assess the efficacy and safety of two commonly applied abdominal wall closure strategies in patients undergoing primary emergency midline laparotomy . Trial registration Background The optimal strategy of  abdominal wall closure after midline laparotomy has remained an issue of ongoing debate . This study was undertaken to describe our own experiences with abdominal fascial closure following elective midline laparotomy and compare with what is described in literature . Methods This was a descriptive prospect i ve study of patients who underwent elective midline laparotomy at Bug and o Medical Centre between March 2009 and February 2014 . Results A total of 872 patients ( M : F = 2.8:1 ) were studied . The median age was 38 years . The fascia closure was performed with a continuous and interrupted sutures in 804 ( 92.2 % ) and 68 ( 7.8 % ) patients , respectively . Mass closure and layered closure were performed in 842 ( 96.6 % ) and 30 ( 3.4 % ) patients , respectively . Monofilament sutures were applied for fascia closure in 366 ( 42.0 % ) patients , multifilament sutures in 506 ( 58.0 % ) patients . Non-absorbable sutures were chosen in 304 ( 34.9 % ) patients , slowly absorbable sutures in 506 ( 58.0 % ) , and moderately absorbable sutures in 62 ( 7.1 % ) patients . Sutures used for fascial closure were vicryl 464 ( 53.2 % ) , nylon 250 ( 28.7 % ) , prolene 62 ( 7.1 % ) , PDSII 54 ( 6.2 % ) and silk 42 ( 4.8 % ) . Sutures with the strength of 0 were used in 214 ( 24.4 % ) patients , with strength of 1 in 524 ( 60.1 % ) patients , and with strength of 2 in 134 ( 15.4 % ) patients . The mean time required for massive closure of the midline incision was 8.20 ± 6.12 min whereas in layered closure , the mean time required for closure was 12.22 ± 7.11 min and this was statistically significant ( p = 0.002 ) . Mass closure was significantly associated with low incidence of wound dehiscence and incisional hernia ( p < 0.001 ) . Continuous suture was significantly associated with low incidence of wound dehiscence and incisional hernia as compared to interrupted suture ( p < 0.001 ) . Non-absorbable sutures were significantly associated with increased incidence of persistent wound pain and stitch sinus as compared to absorbable sutures ( p < 0.001 ) . The use of monofilament sutures was insignificantly associated with low incidence of surgical site infection as compared to multifilament sutures ( p = 0.051 ) . Prolene was significantly associated with persistent wound pain as compared to vicryl ( p = 0.017 ) . Conclusion Continuous mass closure with vicryl is commonly used for abdominal fascial closure following elective midline laparotomy in our setting and gives satisfactory results Abstract . Incisional hernia is a serious postoperative complication of laparotomy . Selecting an appropriate suture material may lessen such morbidity . This study undertook a prospect i ve , r and omized comparison of early-absorbable polyglactin 910 suture versus late-absorbable polydioxanone loop suture for fascial closure after abdominal surgery . A series of 340 consecutive patients undergoing elective laparotomy were r and omized to have fascial closure with either polyglactin 910 suture or polydioxanone loop suture between October 1993 and August 1996 . A 2-year follow-up revealed that 23 patients had died , and the overall mortality rate was 6.8 % ( 23/340 ) . Ten ( 10/340 , 2.9 % ) patients , including seven with polyglactin 910 suture and three with polydioxanone loop suture , developed incisional hernias . The early postoperative evaluation revealed an incidence of wound infection of 4.1 % ( 14/340 ) . The development of incisional hernia was not secondary to postoperative wound infection in this study . Among these 340 patients , 192 had malignant diseases and 148 had nonmalignant ones . Fascial closure with polyglactin 910 suture was associated with more incisional hernias than that with polydioxanone loop suture , with marginal significance for patients in the malignant group ( 4.7 % versus 0 % , p= 0.07 ) but not in the nonmalignant group ( 2.6 % versus 4.2 % , p= 0.67 ) . In conclusion , abdominal closure with a late-absorbable polydioxanone loop suture may be beneficial to patients with a malignant disease for preventing incisional hernia This study describes a prospect i ve r and omized controlled trial to evaluate whether suture of the peritoneal layer is necessary as a separate step in the closure of midline abdominal surgical wounds . Consecutive patients undergoing abdominal operation — elective and emergency surgery — through a midline abdominal wound were r and omized to have the peritoneal layer closed with continuous catgut , or to have this step omitted . The linea alba was closed with interrupted stainless steel sutures , and the skin approximated with staples . Patients were evaluated for wound sepsis , wound dehiscence , and subsequent incisional hernia development . Postoperative pain was assessed by a self-administered visual analogue score , and by measuring narcotic requirements . There was no significant difference in narcotic requirements , pain scores , or wound complications between the 2 groups . Single-layer closure of the abdominal wall is quicker , less costly , and theoretically safer than layered closure , and it is recommended that separate suture of the peritoneum be ab and oned . ResuméDans cette étude prospect i ve , r and omisée , et contrôlée , nous avons cherché à savoir si la fermeture individualisée du péritoine était nécessaire dans la fermeture d'une laparotomie médiane . Deux cents patients consécutifs — opérés à froid ou en urgence — par laparotomie médiane  , ont été r and omisés : dans un groupe , le péritoine a été fermé en un plan individualisé par un surjet au catgut , dans l'autre , le péritoine n'a pas été suturé . La ligne blanche a été fermée en un plan par des points séparés de fils d'acier ; la peau a été fermée par des agrafes . On a étudié le nombre des abcès de paroi , des éviscérations , et , à distance , des éventrations . La douleur postopératoire a été évaluée par un score analogue visuel , établi par le patient lui-même , ainsi que par la nécessité d'utiliser des antalgiques . Il n'y avait pas de différence significative entre les 2 groupes en ce qui concerne le taux de complications pariétales ou l'existence de douleur . Comme la fermeture pariétale en un seul plan est plus rapide , coûte moins cher , et , est théoriquement plus sûre ( on peut surveiller le contenu intrapéritonéal pendant la fermeture ) que la fermeture plan par plan , nous recomm and ons d'ab and oner la fermeture individualisée du péritoine . ResumenEl presente articulo describe un ensayo clínico prospect ivo destinado a investigar si es necesaria la sutura de la capa peritoneal como un paso independiente en el cierre de incisiones abdominales de línea media . Una serie de pacientes consecutivos sometidos a operaciones abdominales fueron r and omizados a cierre peritoneal con sutura continua de catgut  o a omisión de este paso . La línea alba fue cerrada con suturas interrumpidas de acero inoxidable y la piel con agrafes . Se estudió la incidencia de infección de herida , de dehiscencia , y de desarrollo de hernia incisional subsiguientes . La valoración del dolor postoperatorio fue realizada mediante autoevaluación con una escala linear análoga y la determinación de los requerimientos de narcóticos . No se encontraron diferencias significativas en el requerimiento de narcóticos para analgesia , en el nivel de la escala de dolor , o en la tasa de complicaciones entre los 2 grupos . El cierre de la pared abdominal en una capa única es más rápido , menos costoso , y teóricamente más seguro ; por lo tanto , se recomienda ab and onar la sutura del peritoneo Burst abdomen and incisional herniation are continuing problems for the general surgeon . A prospect i ve study was carried out to define the extent of the problem . Over five years from 1975 to 1980 a total of 1129 major laparotomy wounds in adults were assessed at regular intervals for 12 months after operation . There were 19 burst abdomens ( 1.7 % ) and 84 incisional hernias ( 7.4 % ) . The introduction of the mass-closure technique reduced the incidence of burst abdomen from over 3 % in 1975 to 0.95 % in 1979 . It did not , however , improve the rate for incisional hernias , which was 7.6 % in 1979 . Many factors are associated with incisional herniation : old age , male sex , obesity , bowel surgery , type of  suture , chest infection , abdominal distension , and , most important , wound infection . More work is needed to find the ideal method of wound closure , and efforts should be made to eliminate wound infection Background The median laparotomy is frequently used by abdominal surgeons to gain rapid and wide access to the abdominal cavity with minimal damage to nerves , vascular structures and muscles of the abdominal wall . However , incisional hernia remains the most common complication after median laparotomy , with reported incidences varying between 2 - 20 % . Recent clinical and experimental data showed a continuous suture technique with many small tissue bites in the aponeurosis only , is possibly more effective in the prevention of incisional hernia when compared to the common used large bite technique or mass closure . Methods / Design The STITCH trial is a double-blinded multicenter r and omized controlled trial design ed to compare a st and ardized large bite 
    Output:
    
For our primary outcome , the proportion of participants who developed incisional hernia at one year or more of follow-up , we did not find evidence that suture absorption ( absorbable versus non-absorbable sutures , RR 1.07 , 95 % CI 0.86 to 1.32 , moderate- quality evidence ; or slow versus fast absorbable sutures , RR 0.81 , 95 % CI 0.63 to 1.06 , moderate- quality evidence ) , closure method ( mass versus layered , RR 1.92 , 95 % CI 0.58 to 6.35 , very low- quality evidence ) or closure technique ( continuous versus interrupted , RR 1.01 , 95 % CI 0.76 to 1.35 , moderate- quality evidence ) result ed in a difference in the risk of incisional hernia .
Based on this moderate- quality body of evidence , monofilament sutures may reduce the risk of incisional hernia .