A biomechanical study of the reinforced tension line (RTL) - a technique for abdominal wall closure and incisional hernias

Background: The unacceptably high rates of incisional hernia after midline laparotomy and recurrent hernia after hernia operations led us to design a new suture technique of abdominal wall closure. Methods: During 38 autopsies we opened the linea alba exactly at the midline. On one side we inserted a suture thread in the fascia, parallel to the fascial margin. Above this, one interrupted suture each was made in the epigastrium, the umbilical region and the hypogastrium. On the contralateral side we introduced suitable interrupted sutures without a longitudinal thread. All interrupted sutures were loaded with a tensiometer until the thread tore out of the tissue. The data were evaluated statistically by means of the Mann-Whitney U-test. Results: The median rupture strength on the non-reinforced side was 67.5 N and on the reinforced side, 113.3 N (p < 0.0001). With the interrupted suture the rupture was caused by the suture cutting through the tissue in 77.2% of cases, while this could be avoided in all cases on the side treated with the reinforced tension line (RTL). Conclusions: The RTL suture technique reinforces the suture base to withstand an additional tensile load of 40 N. This simple technique can be used for primary abdominal wall closure as well as for incisional hernias and should be compared in the clinical setting in prospective randomized studies with conventional techniques.