Principles of Abdominal Wall Closure: A Narrative Review of Evidence-Based Techniques, Contemporary Updates, and Emerging Innovations

Abdominal wall closure is a critical determinant of postoperative outcomes following laparotomy. Despite advances in surgical technique and perioperative care, complications, such as incisional hernia, wound dehiscence, and surgical site infection (SSI), remain prevalent and contribute significantly to long-term morbidity and healthcare expenditure. Over the past three decades, improved understanding of fascial biomechanics, wound healing physiology, and suture mechanics has reshaped closure strategies. Evidence now supports small bites continuous closure with an adequate suture-to-wound length ratio as a biomechanically superior technique. Selective prophylactic mesh reinforcement in high-risk populations has further reduced hernia incidence. Advances in open abdomen management, component separation techniques, minimally invasive repair, and robotic-assisted closure continue to expand reconstructive options. This narrative review synthesizes anatomical foundations, randomized evidence, preventive strategies, emerging technologies, and complication patterns in abdominal wall closure. Contemporary best practice requires integration of anatomical precision, biomechanical principles, patient risk stratification, and judicious adoption of evolving technologies. Future research should prioritize standardized reporting frameworks, long-term comparative outcomes, and cost-effectiveness analyses.