The abdominal cavity, often described as Pandora’s box, contains a complex interplay of vital organs and physiological processes essential for maintaining homeostasis. Any disruption of this delicate balance by disease, trauma, or infection may necessitate surgical exploration or intervention through laparotomy. Restoration of the abdominal wall following surgery is a critical step because inadequate closure can lead to severe postoperative complications such as wound dehiscence and burst abdomen. The reported incidence of wound dehiscence ranges between 1–6%, while burst abdomen occurs in approximately 1–3% of laparotomies, with an associated mortality of 35–40% in some studies [1]. Multiple factors contribute to wound complications, including patient-related variables such as age, nutritional status, comorbidities (e.g. diabetes, chronic obstructive pulmonary disease), obesity, and habits like smoking, as well as surgical factors such as technique, infection, and postoperative cough or vomiting [2]. Among these, two modifiable technical aspects remain paramount the choice of suture material and the method of wound closure [3]. The ideal suture material for rectus sheath closure should maintain tensile strength until the wound has regained sufficient intrinsic strength through collagen deposition and remodeling, evoke minimal tissue reaction, resist infection, and either be absorbed in synchrony with wound healing or remain inert if non-absorbable [4]. Among the commonly used materials, polyglactin 910 (Vicryl) and polypropylene (Prolene) are popular choices. Vicryl is a synthetic, braided, absorbable suture with effective tensile strength for approximately 2–3 weeks, after which it undergoes hydrolytic degradation. In contrast, Prolene is a non-absorbable, monofilament suture that maintains tensile strength indefinitely, providing long-term mechanical support [5]. However, whether an absorbable suture like Vicryl offers comparable wound integrity and fewer complications than a non-absorbable suture like Prolene remains a topic of debate. Several studies have attempted to address this issue with varying results. Pandey et al. compared Vicryl and Prolene in vertical laparotomy closure and found that wound dehiscence occurred in 17% of cases with Vicryl and 6% with Prolene, suggesting better outcomes with the latter [6]. Conversely, Lalith Kumar et al. in a comparative study of 1-0 Vicryl and 1-0 Prolene for rectus closure observed no statistically significant difference in wound complications, though burst abdomen occurred in 10% of total cases (3 in Prolene, 2 in Vicryl groups) [7]. A meta-analysis by Sajid et al. compared slowly absorbable and non-absorbable sutures for abdominal fascial closure and concluded that there were no significant differences in rates of incisional hernia, wound dehiscence, or infection [8]. Earlier work by Bucknall et al. also found comparable outcomes between monofilament nylon (non-absorbable) and polyglycolic acid (absorbable) for abdominal closure [9]. Despite these studies, controversy persists due to variations in suture type, closure technique (continuous vs interrupted), suture-to-wound length ratio, and patient selection across trials. The available literature demonstrates limited data specifically comparing 1-0 Vicryl and 1-0 Prolene using standardized closure techniques in elective laparotomies. Therefore, a well-designed comparative study focusing exclusively on these two suture materials for rectus sheath closure is warranted to clarify their relative efficacy and safety. While multiple studies have compared absorbable and non-absorbable sutures, few have directly evaluated Vicryl versus Prolene of the same gauge (1-0) in uniform elective conditions. The inconsistency of results and lack of large, standardized, single-center trials create a need for further evidence. Aim of the Study was to compare the use of 1-0 Vicryl and 1-0 Prolene for rectus sheath closure in elective abdominal surgeries and to assess wound healing and complication rates, including wound infection, wound dehiscence, and burst abdomen.

The present prospective, comparative study was conducted in the Department of General Surgery at Owaisi Hospital and Research Centre and Princess Esra Hospital, affiliated with the Deccan College of Medical Sciences, Hyderabad, Telangana, India. The study was carried out over a period of 18 months, from August 2022 to February 2024. Sample Size Based on a reported prevalence of wound dehiscence of approximately 3%, with a 95% confidence level and 5% margin of error, the minimum sample size was estimated to be 45, using the formula n = 4pq/d². To ensure adequate representation and compensate for potential dropouts, a total of 50 patients were included in the study. Inclusion Criteria Patients fulfilling the following criteria were included: • Adults aged 18 to 70 years of either gender. • Patients classified as ASA Grade I or II. • Patients undergoing elective laparotomy for conditions such as umbilical or paraumbilical hernia, incisional hernia, open cholecystectomy, or exploratory laparotomy. Exclusion Criteria Patients were excluded if they met any of the following: • Undergoing emergency surgeries. • Unwilling to participate in the study. • Known cases of chronic obstructive pulmonary disease (COPD) or morbid obesity. • Patients receiving chronic corticosteroid therapy. Ethical Considerations and Informed Consent Prior to commencement, the study protocol was approved by the Institutional Ethics Committee of the Deccan College of Medical Sciences. All eligible participants were provided with a detailed explanation regarding the disease process, treatment options, surgical procedures, and possible complications. Written informed consent was obtained from each patient before enrolment, and participants were informed of their right to withdraw at any stage of the study. Data Collection Procedure Each participant underwent a detailed clinical history, physical examination, and review of hospital records. Demographic, clinical, and operative data were recorded systematically. Eligible patients were randomly allocated into two groups of 25 each: • Group A (Prolene Group): Rectus closure using 1-0 Prolene (polypropylene, non-absorbable monofilament). • Group B (Vicryl Group): Rectus closure using 1-0 Vicryl (polyglactin 910, absorbable braided suture). To minimize bias, all wound closures were performed using a standardized technique: continuous suturing with a suture-to-wound length ratio of 4:1, inter-suture spacing of 1 cm, and a 2 cm margin from the wound edge. Patients were followed up for two weeks postoperatively. During follow-up, wound healing, infection, and early complications such as wound dehiscence or burst abdomen were assessed. Additional variables, including duration of surgery, intraoperative blood loss, glycemic control, and postoperative respiratory infection, were also documented. Variables Recorded Data were categorized as: • Demographic Variables: Age, gender. • Clinical Variables: Diagnosis, surgery performed, type of suture material used, duration of surgery, estimated blood loss, glycemic status, wound infection, and respiratory tract infection. Factors were further classified as: • Surgeon-related: Diagnosis, operative procedure, suture type, duration, and intraoperative parameters. • Patient-related: Comorbidities, glycemic control, and postoperative complications. Statistical Analysis Data were entered into Microsoft Excel 2010 and analyzed using IBM SPSS Statistics for Windows, Version 24.0 (IBM Corp., Armonk, NY, USA). Qualitative data were expressed as frequency and percentage, and associations between categorical variables were assessed using the Chi-square test or Fisher’s exact test, as appropriate. Quantitative data were summarized as mean ± standard deviation (SD) and compared between groups using the paired t-test for normally distributed data or One-Way ANOVA for comparisons involving more than two groups. A p-value < 0.05 was considered statistically significant.

Table 1: Age-wise Distribution of Study Subjects Age Group (years) Group A (Prolene)
N (%) Group B (Vicryl)
N (%) P value Less than 20 0 (0%) 1 (4%) 21–30 1 (4%) 1 (4%) 31–40 6 (24%) 5 (20%) 41–50 14 (56%) 12 (48%) 51–60 3 (12%) 5 (20%) 61–70 1 (4%) 1 (4%) Total 25 (100%) 25 (100%) χ² = 0.1358 Mean ± SD (years) 42.43 ± 1.12 43.12 ± 1.13 t = 0.2315 The age distribution of patients in both study groups was comparable. The majority of participants in both the Prolene (Group A) and Vicryl (Group B) groups were within the 41–50 years age range, accounting for 56% and 48% respectively. Only a small proportion of patients were younger than 30 or older than 60 years. The mean age was 42.43 ± 1.12 years in Group A and 43.12 ± 1.13 years in Group B. Statistical analysis using the t-test and Chi-square test revealed no significant difference (p = 0.2315) between the groups, confirming that both cohorts were well-matched in terms of age distribution (Table 1). Table 2: Baseline characteristics by group (combined) Variable Category Group A (Prolene) N (%) Group B (Vicryl) N (%) P value Gender Male 13 (52%) 14 (56%) 1.131 Female 12 (48%) 11 (44%) Total 25 (100%) 25 (100%) Diabetic status Diabetic 4 (16%) 5 (20%) 0.8672 Non-diabetic 21 (84%) 20 (80%) Total 25 (100%) 25 (100%) BMI (kg/m²) < 18.5 8 (32%) 7 (28%) 0.7863 18.5–24 15 (60%) 14 (56%) > 24 2 (8%) 4 (16%) Total 25 (100%) 25 (100%) Both groups were well balanced at baseline. The proportion of males and females was similar between Prolene and Vicryl groups, as were the shares of diabetic versus non-diabetic patients. BMI categories were also comparable, with most participants in the normal range (18.5–24 kg/m²), fewer underweight, and a small minority overweight. All between-group comparisons were non-significant (p>0.05), indicating that the groups were comparable before assessing outcomes (Table 2). Table 3: Comparison of Type of Incisions Between the Two Groups Type of Incision Group A (Prolene)
N (%) Group B (Vicryl)
N (%) P value Transverse 12 (48%) 11 (44%) Vertical 13 (52%) 14 (56%) 0.9432 Total 25 (100%) 25 (100%) Table 3 shows the distribution of incision types was nearly identical in both study groups. In Group A (Prolene), 52% of patients underwent vertical incisions and 48% had transverse incisions, while in Group B (Vicryl), 56% had vertical and 44% had transverse incisions. Statistical analysis yielded a p-value of 0.9432, indicating no significant difference between the two groups. Thus, both groups were comparable regarding the type of incision used, minimizing incision type as a potential confounding variable in assessing wound healing outcomes. Table 4: Distribution of Study Subjects According to the Incidence of Burst Abdomen Burst Abdomen Group A (Prolene)
N (%) Group B (Vicryl)
N (%) P value Yes 1 (4%) 7 (28%) No 24 (96%) 18 (72%) 0.01 Total 25 (100%) 25 (100%) The incidence of burst abdomen was significantly higher in the Vicryl group (Group B) compared to the Prolene group (Group A). Among patients in Group B, 7 cases (28%) developed burst abdomen, whereas only 1 case (4%) occurred in Group A. Statistical analysis showed a p-value of 0.01, indicating a statistically significant difference between the two groups. This suggests that Prolene (non-absorbable suture) provided superior tensile strength and wound integrity compared to Vicryl (absorbable suture) for rectus sheath closure, thereby reducing the risk of postoperative wound dehiscence and burst abdomen (Table 4). Table 5: Distribution of Study Subjects According to the Day of Burst Abdomen Occurrence Day of Burst Abdomen Occurrence Group A (Prolene)
N (%) Group B (Vicryl)
N (%) P value Day 2 0 (0%) 0 (0%) Day 5 1 (100%) 4 (57.14%) Day 8 0 (0%) 3 (43.85%) 0.02 Total 1 7 The timing of burst abdomen occurrence varied between the two study groups. In Group A (Prolene), the single case of burst abdomen (4%) occurred on postoperative day 5. In contrast, in Group B (Vicryl), four patients (57.14%) developed burst abdomen on day 5, while three patients (43.85%) experienced it on day 8. No cases were observed on day 2 in either group. The statistical analysis revealed a significant difference (p = 0.02) between the two groups, indicating that the incidence of burst abdomen was not only higher but also occurred later and more frequently among patients with Vicryl closures. This finding further supports the superior wound strength and reliability of Prolene sutures for rectus sheath closure in maintaining fascial integrity during the critical postoperative period (Table 5). Table 6: Distribution of Study Subjects According to Incidence of Surgical Site Infections (SSI) Surgical Site Infections Group A (Prolene)
N (%) Group B (Vicryl)
N (%) P value Present 4 (16%) 8 (32%) Absent 21 (84%) 17 (68%) 0.01 Total 25 (100%) 25 (100%) The incidence of surgical site infections (SSI) was notably higher in the Vicryl group (Group B) compared to the Prolene group (Group A). In Group A, only 4 patients (16%) developed wound infections, whereas 8 patients (32%) in Group B experienced postoperative wound infection. The difference between the two groups was found to be statistically significant (p = 0.01). This suggests that the use of Prolene sutures for rectus sheath closure is associated with a lower incidence of surgical site infection compared to Vicryl, possibly due to Prolene’s monofilament structure, which minimizes bacterial adherence and tissue reaction (Table 6). Table 7: Distribution of Study Subjects According to the Type of Surgical Site Infections Type of Surgical Site Infection Group A (Prolene)
N (%) Group B (Vicryl)
N (%) P value Pus discharge 2 (66.67%) 5 (62.5%) Infected seroma 1 (33.33%) 3 (37.5%) 0.04 Total 3 8 Among the patients who developed surgical site infections (SSI), the most common presentation in both groups was purulent (pus) discharge from the wound. In Group A (Prolene), 2 patients (66.67%) presented with pus discharge and 1 patient (33.33%) developed an infected seroma. Similarly, in Group B (Vicryl), 5 patients (62.5%) had pus discharge and 3 patients (37.5%) showed infected seroma formation. Statistical analysis demonstrated a significant difference (p = 0.04), indicating that Vicryl group had a higher overall incidence of surgical site infection types compared to the Prolene group. The findings reinforce the notion that Prolene sutures, due to their monofilament structure and minimal tissue reactivity, are less prone to infection compared to Vicryl, which is braided and more susceptible to bacterial colonization. (Table 7) Table 8: Distribution of Study Subjects According to Rate of Wound Healing Rate of Wound Healing Group A (Prolene)
N (%) Group B (Vicryl)
N (%) P value > 4–6 weeks 0 (0%) 0 (0%) 4–6 weeks 17 (68%) 10 (40%) < 4–6 weeks 8 (32%) 15 (60%) 0.001 Total 25 (100%) 25 (100%) The rate of wound healing was significantly faster in patients who underwent rectus sheath closure with Vicryl (Group B) compared to those with Prolene (Group A). In Group B, 15 patients (60%) achieved wound healing in less than 4–6 weeks, whereas only 8 patients (32%) in Group A healed within this time frame. Conversely, 68% of patients in Group A and 40% in Group B required up to 4–6 weeks for complete wound healing. No patients in either group had delayed healing beyond six weeks. The difference was statistically significant (p = 0.001), indicating that wounds closed with Vicryl, an absorbable suture, demonstrated earlier healing, possibly due to reduced long-term foreign-body reaction (Table 8).

This prospective, comparative study evaluated outcomes of rectus sheath closure with 1-0 polypropylene (Prolene) versus 1-0 polyglactin-910 (Vicryl) in elective laparotomy. The two groups were well matched for age, sex, diabetes, BMI, indication for surgery, incision type, and intra-operative hypotension, reducing selection bias from known confounders. Using a standardized continuous closure with a suture-to-wound length ratio of 4:1, we observed three main findings: (i) burst abdomen was significantly less frequent with Prolene than Vicryl (4% vs 28%; p=0.01); (ii) surgical-site infection (SSI) was lower with Prolene (16% vs 32%; p=0.01), with more cases of purulent discharge and infected seroma in the Vicryl group; and (iii) early clinical wound healing was faster with Vicryl (<4–6 weeks: 60% vs 32%; p=0.001). The timing of fascial failure clustered on postoperative day 5–8, which aligns with the biological window when collagen deposition is still immature and fascial tensile strength depends largely on the suture–tissue complex [10]. These results are mechanistically plausible. Polypropylene is a nonabsorbable monofilament with sustained tensile strength and low tissue drag; braided Vicryl, while dependable for 2–3 weeks, undergoes rapid hydrolysis thereafter and has greater capillarity and surface area for bacterial adherence, factors linked to higher SSI in experimental and clinical work comparing braided and monofilament materials [11]. Lower infection with monofilament suture can secondarily reduce early fascial failure because infection weakens suture–tissue holdfast and promotes knot loosening or “cheese-wiring” through edematous fascia [12]. Our burst-abdomen finding closely mirrors the randomized trial by Pandey et al., who reported significantly less dehiscence with polypropylene than Vicryl in mass closure of vertical laparotomy wounds (dehiscence 6% vs 17%) [13]. It is also consistent with the classic randomized comparison by Bucknall et al., where nonabsorbable monofilament nylon produced fewer wound failures than absorbable polyglycolic acid (4.7% vs 12.5%) in abdominal closure [14]. Conversely, the recent single-center study from Chengalpattu that compared 1-0 Vicryl and 1-0 Prolene for rectus closure reported no significant difference in early dehiscence, although the absolute number of burst abdomens favored Prolene (3 vs 2) and the study was underpowered for this endpoint [15] (the latter reports early outcomes up to two weeks). Meta-analytic data that pool slowly absorbable monofilament sutures (predominantly PDS) versus nonabsorbable materials suggest similar risks of dehiscence and hernia overall [16]. This is important context: guidelines that recommend a continuous small-bites technique with a slowly absorbable monofilament for elective midline laparotomy closure are largely based on evidence with PDS rather than braided, rapidly absorbable Vicryl [17]. Our findings therefore do not contradict guideline recommendations; instead, they highlight that Vicryl behaves differently from slowly absorbable monofilaments and that material class (braided vs monofilament; rapid vs slow absorption) matters as much as “absorbable vs nonabsorbable.” The higher SSI in the Vicryl arm aligns with microbiological and animal data showing greater bacterial adherence to braided sutures and lower adherence to monofilament structures [18]. Although our study was not designed to test causal pathways, this difference likely contributed to the higher burst-abdomen rate in the Vicryl group. The observation that clinical healing appeared faster with Vicryl is also biologically reasonable: the earlier loss of foreign material and slightly greater tissue integration with braided absorbables can improve short-term cosmesis and wound epithelialization, yet this benefit may be offset by reduced fascial support during the critical week 1–2 window. Methodologically, our standardized closure followed Jenkins’ 4:1 suture-to-wound length principle, which reduces mechanical failure from suture cut-out [19]. We did not use the small-bites technique; consequently, our results apply to continuous mass closure. Strengths include prospective design, uniform technique, and comparable baseline risk. Limitations include single-center setting, modest sample size, and short follow-up restricted to early complications; we could not assess incisional hernia, chronic pain, or suture sinus over the long term. Another limitation is that “time to clinical healing” captures skin and superficial aspects more than deep fascial remodeling; ultrasound or CT assessment of fascial integrity could refine this endpoint in future work. Our data favor Prolene, consistent with Pandey et al. and with earlier randomized evidence comparing nonabsorbable monofilament to braided absorbables [13]. The Chengalpattu series reported no significant difference but was small and showed numerically more events with Prolene than Vicryl (opposite direction), underlining heterogeneity across small studies [7]. Lower SSI with Prolene in our cohort aligns with experimental and clinical observations that monofilament sutures harbor fewer bacteria and reduce infection risk compared with braided sutures [11]. Contemporary guidance suggests continuous small-bites closure with slowly absorbable monofilament (e.g., PDS) for elective midline laparotomy to reduce hernia and SSI [17]. Our study compares Prolene to braided Vicryl, not to PDS; taken together with meta-analyses showing parity between PDS and nonabsorbables [8], our results suggest that if an absorbable is preferred, a slowly absorbable monofilament may better balance infection and support risks than Vicryl.

In elective midline laparotomy using standardized continuous mass closure, polypropylene (Prolene) produced fewer burst-abdomen events and surgical-site infections than polyglactin-910 (Vicryl). Vicryl showed faster superficial healing but at the cost of higher early fascial failure and infection risk. Where an absorbable suture is preferred, current evidence supports a slowly absorbable monofilament (e.g., PDS) with a small-bites technique rather than braided, rapidly absorbable materials. Larger multicenter studies with longer follow-up should directly compare Prolene with PDS and assess late outcomes such as incisional hernia.

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