Polypropylene Versus Polydioxanone Sutures for Fascial Closure in Emergency Midline Laparotomy: A Retrospective Comparative Study.

Background Emergency midline laparotomy is a commonly performed life-saving procedure and is associated with a high risk of postoperative wound complications, including surgical site infection, burst abdomen, and incisional hernia. Optimal fascial closure is critical for maintaining wound integrity, particularly in emergency and contaminated settings where mesh reinforcement is often not feasible. Polypropylene (Prolene®, Ethicon, a Johnson & Johnson company, Somerville, NJ, USA) and polydioxanone or PDO (PDS®, Ethicon, Somerville, NJ, USA) are among the most frequently used sutures for abdominal fascial closure; however, comparative evidence in emergency laparotomy remains limited. Objective To compare postoperative wound outcomes and operative parameters following fascial closure using polypropylene versus PDO sutures in patients undergoing emergency midline laparotomy. Methods This retrospective observational comparative study included 80 adult patients who underwent emergency midline laparotomy with primary fascial closure, of whom 40 received polypropylene sutures, and another 40 received PDO sutures. Baseline demographic characteristics, comorbidities, and surgical indications were comparable between groups. Postoperative outcomes assessed included burst abdomen, surgical site infection within 30 days, incisional hernia at six months, operative duration, skin closure time, and length of hospital stay. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of incisional hernia. Results Patients in the PDO group demonstrated significantly lower rates of burst abdomen (2.5% vs 7.5%), surgical site infection (10% vs 17.5%), and incisional hernia (5% vs 10%) compared with the polypropylene group (p<0.05 for all). Mean skin closure time and overall operative duration were significantly shorter in the PDO group, and median hospital stay was reduced. On multivariate analysis, wound contamination emerged as the only independent predictor of incisional hernia (adjusted odds ratio or aOR 4.76; 95% CI: 1.01-22.41; p=0.048), while suture material did not retain independent significance. Conclusion PDO sutures were associated with lower rates of wound-related complications compared to polypropylene sutures in this retrospective cohort. However, given the non-randomized design and limited sample size, these findings should be interpreted cautiously. Wound contamination remained the only independent predictor of incisional hernia. Further prospective studies are required to confirm these observations.