Herring Bone Stitch: Knitting to Secure Abdominal Wall Closure for Emergency Midline Laparotomy

Secure abdominal wall closure after any laparotomy is every surgeon’s aim. However, in spite of all scientific advancements, better suture materials and different/ modified closure techniques; 5-26% of patients develop incisional hernia (IH) after midline laparotomy 1-6. This figure goes further up if high risk groups are analyzed separately or if the follow up is for a period longer than 3 years 7-10. Surgeons have risen to this challenge and have tried different sutures, techniques and even prophylactic mesh placement; with varying degree of success. We hypothesized that a simple ‘herring bone’ stitch repair can provide secure abdominal wall closure and minimize the incidence of IH in patients undergoing emergency midline laparotomy.