Slowly absorbable suture for fascial defect closure in open incisional hernia mesh-repair is associated with decreased long-term recurrence: a nationwide cohort study

PURPOSE: Recurrence after incisional hernia repair is an important outcome measure with rates still ranging high. For open incisional hernia repair a mesh-based technique with fascial defect closure is recommended, but there is no evidence supporting the choice of suture used for the defect closure. Slowly absorbable suture has been advised as reducing the risk of primary incisional hernia formation after abdominal surgery, but whether this applies as best choice compared to non-absorbable suture in open incisional hernia repair with mesh is undetermined. METHOD: This was a nationwide registry study with a 100% follow-up from 2007 to 2022. Eligibility criteria were elective open incisional hernia surgery, mesh-based technique, and fascial defect closure with slowly absorbable or non-absorbable suture. The 5-year cumulative incidence of reoperation for hernia recurrence was determined. Confounders were included in multivariate regression analyses. RESULTS: A total of 3393 patients were included. Mean (sd) age was 60.6 (13) years and 50% were females. Mean horizontal defect size was 6.4 (4.7) cm and 1900 (56%) patients had vertical incisions. Incidence of 90-day surgical reintervention was 143 (4.2%). Median (IQR) follow-up was 3.5 (1.6–3.8) years, and 249 (7.3%) patients underwent operation for recurrence. Cox regression analysis showed that non-absorbable suture was associated with a significantly increased risk of operation for recurrence compared to slowly absorbable (HR 1.33, CI 1.01–1.76, P = 0.043). Type of suture was not associated with increased risk of 90-day reoperation. CONCLUSION: Using a slowly absorbable suture for fascial closure is associated with a decreased risk of long-term hernia recurrence compared to non-absorbable suture after open incisional hernia mesh-repair.