What is the Proper Technique for Primary Laparotomy Closure?

A midline laparotomy remains the most common open method of surgical access to the abdominal cavity. This incision allows adequate visualization of the entirety of the abdominal contents and avoids injury to vascular, muscular, or neurologic structures. Unfortunately, the Achilles heel of this incision remains the high rate of incisional hernias after its use. Despite an increased awareness of this issue, hernia rates have not significantly decreased in the modern surgical era, still occurring 10% to 40% of the time after midline laparotomy [1,2].