Current Practices in Midline Laparotomy Closure: Results of a Portuguese National Survey

Introduction: Incisional hernias after midline laparotomy significantly affect quality of life and healthcare costs. Adequate fascial closure, including evidence-based suture techniques and the use of prophylactic mesh in selected patients, is essential for prevention. This study aimed to evaluate current abdominal wall closure practices in Portugal. Methods: A 26-question online national survey was conducted and shared through surgical societies, email lists, and social media. The questionnaire addressed surgeon demographics, suture materials, closure techniques, prophylactic mesh use, and abdominal wall practices related to stoma creation and emergency settings. Results: A total of 233 surgeons completed the survey (31.2% residents; 68.8% consultants). Long-lasting absorbable sutures were preferred for laparotomy closure (47%) and burst abdomen repair (39.3%). The small-bites technique was known by 94.4% of surgeons, correctly understood by 77.4%, but only 59.8% routinely applied the recommended 4:1 suture length-to-wound length ratio. More than 60% reported never using prophylactic mesh, even during definitive colostomy creation. Techniques for burst abdomen management varied widely. Conclusion: Abdominal wall closure practices in Portugal remain highly variable, with only partial adherence to guideline-recommended techniques. Key components such as the 4:1 suture length-to-wound length ratio and the selective use of prophylactic mesh—particularly in high-risk patients and during definitive stoma creation—are underutilized. These findings highlight the need for wider guideline dissemination and structured training to promote more uniform, evidence-based practice.