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Incisional hernias follow approximately 3% of major laparoscopic procedures when the fascia is not adequately closed. Fascial closure, however, is difficult when skin incisions are small and subcutaneous tissue is thick. We report the development of a self-contained device that sutures the anterior abdominal wall peritoneum and fascia at the completion of laparoscopic surgery without extending the cutaneous incision.

Three hundred patients undergoing celiotomies had fascial incisions closed using O-Maxon looped suture employing a knot-free running modification of the Smead Jones method. Two hundred ninety-three patients were evaluated prospectively to determine efficacy and safety of this technique. Seventy-two percent of patients underwent celiotomies for treatment of malignant diseases. A vertical incision was used in 79% and a transverse incision in 21% of patients. Mean fascial closure time was 8.4 minutes (range 3-32), without a significant difference between the vertical and transverse incisions. Overall suture handling was judged as excellent in 44% of the patients and good in 54%. Six weeks postoperatively, wounds were healed in 99% of patients, with less than 1% having residual infection or unclosed, granulating wounds. No herniation or fascial dehiscences occurred in this series. We conclude that Maxon looped suture employing a knot-free running Smead Jones technique appears to be a safe, efficient, and effective closure method in this group of patients. Further follow-up will be required to show whether this outcome is sustained.