ORIGINALARTICLE

COMPARISON OF VICRYL VERSUS PROLENE SUTURE IN CLOSURE OF MIDLINE RECTUS

SHEATH FOLLOWING ELECTIVE LAPAROTOMY: A RANDOMIZED CONTROLLED TRIAL

Sabin Rauf¹, Gohar Ali²Musarrat Hussain³, Unsia Fatima¹, Aqib Ali Khan¹, Sana Rasheed¹, Muhammad Bilal¹

How to cite this article

ABSTRACT

OBJECTIVES

Rauf S, Ali G, Hussain M, Fatima U,

Khan AA, Rasheed S, et al.

Comparison of Vicryl Versus Prolene

Suture in Closure of Midline Rectus

Sheath Following Elective

Laparotomy: A Randomized

This aimed to compare the incidence of wound dehiscence and surgical site

infections following midline rectus sheath closure with Prolene and Vicryl

sutures after laparotomy.

METHODOLOGY

This prospective, randomized, controlled trial was conducted in the

Department of General Surgery at Hayatabad Medical Complex, Peshawar,

over 6 months. A total of 152 patients (aged 18–70 years) undergoing elective

midline laparotomy were randomly divided into two groups using simple

randomization by coin-ip method: Group A (Prolene) and Group B (Vicryl),

each consisting of 76 patients. Both groups underwent standardized

continuous mass closure with a 4:1 suture-to-wound length ratio. Post-

operative follow-up continued for 30 days at post-operative days 7, 14, and

30, to assess wound dehiscence, surgical site infection, and hospital stay.

Data were analyzed using SPSS version 23, with p ≤ 0.05 considered

signicant.

Controlled Trial. J Gandhara Med

Dent Sci. 2026;13(2):40-44

https://doi.org/10.37762/jgmds.13-2.821

Date of Submission: 19-11-2025

Date Revised:

14-03-2026

Date Acceptance: 15-03-2026

¹Trainee Medical Ofcer, Department of

Surgery, Surgical Unit Hayatabad

Medical Complex, Peshawar

²Trainee Registrar, Department of

Surgery, Surgical Unit, Hayatabad

Medical Complex, Peshawar

RESULTS

Wound dehiscence occurred in 4 (5.3%) patients in the Prolene group

compared with 10 (13.2%) in the Vicryl group (p<0.05). Surgical site

infections were also signicantly lower in the Prolene group 11 (14.4%)

compared to the Vicryl 25 (32.9%) (p< 0.05). The hospital stay was slightly

longer in the Vicryl group (7±2 vs 5±2), which was mainly due to post-

operative complications (p<0.05).

Correspondence

³Musarrat Hussain, Associated

Professor, Department of Surgery,

Surgical Unit Hayatabad Medical

Complex, Peshawar

CONCLUSION

Closure of the midline rectus sheath with Prolene results in signicantly

fewer cases of wound dehiscence and surgical site infections compared to

Vicryl. Prolene may be considered a favorable option for midline laparotomy

closure to minimize post-operative complications and improve patient

outcomes.

+92-333-9212173

drmusarrat9740@gmail.com

KEYWORDS: Prolene, Vicryl, Midline Laparotomy, Wound Dehiscence,

Surgical Site Infection

site infections, comorbidities, and wound closure

technique. However, patient-related factors such as age,

INTRODUCTION

gender, BMI, smoking, or alcohol abuse or systemic

Illnesses also contribute.^1,7,8So, the ultimate preventive

strategy is an optimal closure technique under the

surgeon’s control.⁹Over the last decade, several eorts

have been made to determine the gold standard

technique for wound closure.³To develop this, several

suturing materials (such as monolament v/s braided

materials, slowly or rapidly absorbable v/s non-

absorbable) and suturing techniques (continuous v/s

Laparotomy is one of the most commonly performed

operations in general surgery. Opening of the abdomen

through the midline is a quick and bloodless preferred

approach, especially in emergency laparotomy

procedures.^1,2,3Closure of the abdomen after

laparotomy is a major concern and is associated with

some complications. Laparotomy wound dehiscence

(LWD), also known as burst abdomen, is a devastating

complication after closure of the abdomen.^4,5

Laparotomy wound dehiscence is dened as the

separation of muscle layers or the aponeurotic layer of

the laparotomy wound before healing.⁵Wound

dehiscence occurs when wound closure provides

insucient strength to the wound to bear the stress

forces.^5,6So, when these forces become stronger than

the wound strength, it results in wound dehiscence.^1,7

interrupted) were studied.¹⁰

meta-analysis and

multiple studies have demonstrated that a continuous

small-bite

suturing

technique

using

Prolene

significantly reduces wound dehiscence compared to

Vicryl in midline laparotomy closure.^11,12,13The

rationale of this study is to compare post-operative

wound dehiscence following closure of the midline

Major risk factors for wound dehiscence are surgical rectus sheath with Vicryl and Prolene after elective

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Comparison of Vicryl Versus Prolene Suture in Closure

according to standard guidelines. Skin was closed with

interrupted non-absorbable sutures. standard

laparotomy. Although several international studies have

compared dierent suture materials, data from regional

populations remain limited, and surgical practices vary

across institutions. Identifying the suture material

associated with a lower risk of wound dehiscence will

inform surgical decision-making and may help establish

standardized best practices. This study aims to evaluate

the incidence of wound dehiscence and surgical site

infections following closure of the midline rectus

sheath with vicryl and Prolene in midline laparotomy.

perioperative care, including the supervision of a senior

specialist surgeon, antibiotics, and wound care, was

provided to all patients. All patients were followed for

30 days postoperatively through hospital visits or

outpatient follow-up at post-operative days 7, 14, and

30. Loss of follow-up excluded the sample from the

study.

Wounds

were

examined

clinically

for

dehiscence, which is dened as the separation of wound

edges or visible underlying structures or evisceration of

abdominal contents. All ndings were documented on a

structured proforma, and outcomes were analyzed. The

primary outcome was the incidence of wound

dehiscence within 30 days; associations with

demographic and clinical variables, including age,

gender, BMI, and comorbidities, were analyzed as

secondary outcomes. Surgical site infection (SSI),

according to the Centers for Disease Control and

Prevention (CDC), is an infection occurring within 30

days after surgery involving the incision or deep tissues

at the operative site with purulent discharge, positive

culture, local signs of inammation, or diagnosis by the

treating surgeon. Data were analyzed using IBM SPSS

version 23.0. quantitative variables, such as age and

BMI, were presented as mean ± standard deviation or

median (IQR), depending on normality, as assessed by

the Shapiro–Wilk test. These were compared using an

independent-samples t-test or a Mann-Whitney U test,

where appropriate. Qualitative variables, such as gender

and wound dehiscence, were reported as frequencies

and percentages. The Chi-square test was applied to

compare the incidence of wound dehiscence between

the Prolene and Vicryl groups, and a p-value ≤ 0.05 was

considered statistically signicant.

METHODOLOGY

This prospective, randomized controlled trial (RCT)

was conducted at the Department of General Surgery,

Hayatabad Medical Complex, Peshawar, over

months. The study was approved by the Ethical Review

Board (HMC-QAD-F-2019) and conducted in

accordance with the Declaration of Helsinki (IREB No.

1680).¹⁴This trial is registered at ClinicalTrials.gov

(NCT07451990), nal updated on 4 March, 2026. All

patients aged 18 to 70 years undergoing midline

laparotomy for various abdominal pathologies were

considered eligible for inclusion in the study. Patients

with malnutrition or anemia (Hb

10 g/dL),

immunocompromised states or active infections; prior

chemotherapy or radiotherapy; pregnancy; or previous

midline laparotomy were excluded. The calculated

sample size was 152 (76 per group) using WHO sample

size calculator for comparison of two proportions with

parameters like level of signicance (α): 5%, power of

the test (1–β): 80%, expected incidence of wound

dehiscence in Prolene group: 6.9%, expected incidence

in Vicryl group: 16.9%.¹³formula for comparing two

proportions:

RESULTS

A total of 152 patients were included, with 76 patients

each in Group A (Prolene) and Group B (Vicryl). The

eligibility consort ow chart is shown in Figure S1. As

shown in Table 1, the mean age was 38.7 ± 11.99 years,

and the data distribution was approximately symmetric

(skewness-0.049). No age-related dierences were

where ₁and ₂are the expected proportions of wound

dehiscence in the Prolene (6.9%) and Vicryl (16.9%)

groups,

= (

₂)/2,

_1-α/2is the standard normal

is the

observed between Groups

and B, and most

deviate for a two-sided α of 0.05 (1.96), and

standard normal deviate for 80% power (0.84). ¹P^-atients

were consecutively enrolled and then randomly

assigned into two equal groups (Group A and Group B)

using the ip-coin method. Group A underwent midline

rectus-sheath closure with Prolene 1 (polypropylene,

non-absorbable monolament) using a continuous mass

closure technique, while Group B had closure with

Vicryl 1 (polyglactin 910, absorbable braided) using the

same technique. In both groups, a suture-to-wound

length ratio of 4:1, with 5 mm spacing, was maintained

participants were aged 31 to 50 years. Among these

females, 64.5% were in the Prolene group and 76.3% in

the Vicryl group, while among males, 35.5% were in

the Prolene group and 23.7% in the Vicryl group. The

mean BMI was 23.79 ± 3.48 kg/m², and the distribution

was roughly symmetric. In results, both groups were

comparable in baseline characteristics, including age,

gender, BMI, and comorbidities, as shown in Tables 1

and 2.

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Comparison of Vicryl Versus Prolene Suture in Closure

Table 1: Baseline Demographic and Clinical Characteristics of

Note: Data are presented as numbers (%) for categorical variables and

mean ± standard deviation (SD) for continuous variables. Wound

dehiscence is further classied as partial or complete. Statistical

signicance was considered at p < 0.05.

Patients in Prolene and Vicryl Groups.

Group A GroupB Total

Variable

(Prolene) (Vicryl) (n= 152) value

n = 76

39.7 ±

9.5

However, wound dehiscence occurred signicantly less

often in the Prolene group (5.3%) compared to the

Vicryl group (13.2%) (p = 0.001). Furthermore, partial

and complete dehiscence were less frequent in the

prolene group than in the Vicryl group. The mean day

of dehiscence was earlier in the Prolene group (5.6 ±

3.1 days) than in the Vicryl group (8.1 ± 1.2 days),

though this dierence was not statistically signicant (p

= 0.078). The Prolene group showed signicantly less

wound dehiscence (p = 0.000) and fewer surgical site

infections (14.5% vs. 32.9%, p = 0.001). Although the

hospital stay was longer, this was mainly related to

managing post-operative complications. Table 2 and

Figure 1 and 2, also show that Group A had lower

incidence of surgical site infections however the wound

dehiscence occurs earlier than Group B. gure 1 show,

wound dehiscence occurred in 5.3% of the Group A and

13.2% of the Group B, with partial dehiscence seen in

2.6% vs. 7.9% and complete dehiscence in 2.6% vs.

5.3%, respectively showing signicantly better

outcomes with Prolene sutures. Figure 2 shows that

surgical site infections occurred in 25 patients in the

Vicryl group, compared with 11 in the Prolene group.

Age (years), mean ± 36.1 ±

38.7 ±

11.9

0.083

0.462

9.1

Age Categories, years

<20.

21–30

31–40

41–50

Above 50

Gender

Male

0.147

(35.5%)

(23.7%) (29.6%)

Female

107

(64.5%)

(76.3%) (70.4%)

BMI (kg/m²) (mean 20.3 ±

25.1 ±

8.1

23.7 ± 2.3 0.071

± SD)

3.0

BMI Categories

Underweight (<18.5 02

kg/m²)

0.433

Healthy

Weight 48

(18.5–24.9 kg/m²)

Overweight (25.0 - 21

29.9 kg/m²)

Obesity (30.0 and 05

above kg/m²)

Diabetes Mellitus

0.064

0.298

0.184

0.398

0.093

Yes

119

Hypertension

Yes

125

Smoking

Yes

102

Steroid Use

Yes

128

Chronic Anemia

Yes

123

Note: Data are presented as mean ± standard deviation (SD) for

continuous variables (independent sample t-test) and as number (%)

for categorical variables(chi-square). Group A (Prolene) and Group B

(Vicryl) each included 76 patients. BMI: Body Mass Index.

Figure 1: Comparison of Wound Dehiscence between Prolene and

Vicryl Groups

Table 2: Post-operative Outcomes in Prolene and Vicryl Groups

Outcome Sub

Groups (Prolene) (Vicryl) n = 152

n = 76 n = 76

Group A Group B Total

P-

value

Wound

Dehiscence No

Partial

Yes

4(5.3%) 10(13.2%) 14(9.2%)

0.001

72(94.7%)

2(2.6%)

complete 2(2.6%)

mean ± 5.6±3.1

138(90.8%)

8(5.3%)

66(86.8%)

6(7.9%)

6(3.9%)

4(5.3%)

Day of

8.1±1.2

7.6±4.5

0.078

Dehiscence SD

Surgical

Site

Yes

11(14.4%) 25(32.9

36(23.3%) 0.001

65(85.5%) 51(67.1%) 116(76.6%)

Infection

Length of Number 5±2

7±2

0.001

hospital

stay

of Days

Figure 2: Comparison of Surgical Site Infections between Prolene

and Vicryl Groups

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Comparison of Vicryl Versus Prolene Suture in Closure

with Vicryl. The overall incidence of wound dehiscence

was 11.5 % in this study.^12,13Several studies support the

present ndings that Prolene sutures result in fewer

wound complications than Vicryl, as in our study.

However, other studies, such as those by Zahra et al.

and Alam et al., found no signicant dierence

between the two materials, suggesting that surgical

technique and infection control may play a greater role

than suture type alone.^6,15Thus, dierences in suture

types aect post-operative complications, indicating

that

meticulous

surgical

technique,

patient

comorbidities, and infection control also play important

roles in preventing post-operative complications.^16,17,18

This was a single-center study with a short (30-day)

follow-up period and no blinding. Long-term

complications, such as incisional hernia, were not

assessed. Hernias or wound dehiscence often occur not

because the suture material itself breaks, but because

the suture pulls through the adjacent edematous,

weakened, traumatized tissue during the early healing

phases. This is particularly an issue in the metabolically

active zone, where proteases break down the native

tissue matrix as part of the repair process. We

recommend future multicenter studies with extended

follow-up to assess long-term outcomes of dierent

suture materials and closure techniques in abdominal

wall surgery.

Figure S1: CONSORT flow diagram showing patient selection,

randomization, allocation, follow-up, and analysis

DISCUSSION

this study demonstrates that closure of the midline

rectus sheath with Prolene is associated with fewer

CONCLUSIONS

post-operative

complications,

including

wound

dehiscence and surgical site infection, compared with

Vicryl. These ndings align with those of Diener et al.,

who concluded that continuous suturing with slowly

absorbable monolament sutures and a 4:1 ratio

provides optimal strength and lower complications.¹¹

Similarly, Pandey et al. and Fortelny et al. reported

lower dehiscence with Prolene (6%) compared to

Vicryl (17%).^12,13Fortelny et al. also supported the use

of continuous small-bite monolament suturing to

reduce post-operative complications.¹²In the present

study, the closure was standardized by continuous small

bite mass closure with both groups, and a constant ratio

of suture length was used, ensuring that the only

variable was suture material. This reects the point

distinction between the outcome of using Prolene vs

Vicryl when all other operative factors are controlled.

Another randomized controlled trial involving 100

patients, in which the incidence of wound dehiscence

after Vicryl and Prolene was studied, also supports the

findings of this study. The incision was closed by

continuous far and near suture technique using

polypropylene (Prolene) suture in one group and a

synthetic delayed absorbable polyglactin 910 (Vicryl)

suture in the other group. There was a signicant

difference in the incidence of wound dehiscence

between the two groups: 6% with Prolene and 17%

This study demonstrates that midline laparotomy

wound closure with Prolene is associated with fewer

post-operative wound complications, including wound

dehiscence and surgical site infection, compared to

closure with Vicryl suture. Using a standardized

continuous small-bite closure with a consistent suture-

to-wound length ratio of 4:1 shows that the type of

suture, rather than the closure technique, aects

outcomes.

CONFLICT OF INTEREST: None

FUNDING SOURCES: None

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AUTHORS CONTRIBUTION

Sabin Rauf - Concept & Design; Data Acquisition;

Drafting Manuscript; Final Approval

Gohar Ali- Concept & Design; Data Acquisition; Data

Analysis/Interpretation; Drafting Manuscript; Critical

Revision; Supervision; Final Approval

Musarrat Hussain - Concept & Design; Data Acquisition;

Data Analysis/Interpretation; Drafting Manuscript;

Supervision; Final Approval

Unsia Fatima - Concept & Design; Data Acquisition;

Drafting Manuscript; Critical Revision; Final Approval

Aqib Ali Khan - Concept & Design; Data Acquisition;

Data Analysis/Interpretation; Drafting Manuscript; Final

Approval

Sana Rasheed - Concept & Design; Data Acquisition;

Drafting Manuscript; Final Approval

Muhammad Bilal - Concept & Design; Data Acquisition;

Drafting Manuscript; Final Approval

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S, Lindahl AK. Post-operative wound dehiscence after

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The authors accept responsibility for all aspects of the work

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integrity of any part are properly investigated and resolved.

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