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June 29, 1979, Vol 241, No. 26 >
ARTICLE | June 29, 1979

Closure of Peritoneum

Thomas E. Elliott, MD
JAMA. 1979;241(26):2786. doi:10.1001/jama.1979.03290520014015.
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ABSTRACT

To the Editor.—  Regarding the answers by Goldenberg (240:1904, 1978) to the predisposing factors to formation of an incisional hernia, I would agree with all but one of his points. He implies that breaking of a peritoneal closure suture would be a predisposing factor and, therefore, by implication, that closing the peritoneum must be good. My associates and I have not closed the peritoneum for ten years, and I have been unable to find any evidence in the literature to suggest that peritoneal closure is important. In fact, all studies suggest that it is detrimental, causing more intraperitoneal adhesions.Besides the other factors mentioned, I believe that obesity, a larger suture site, sutures placed at least 1 cm back from the fascial edge, and sutures tied to approximate rather than strangulate (if a running suture is not used) should be added to Dr Goldenberg's list.

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