Current practices and attitudes toward rectus sheath closure among surgeons: A cross-sectional study.
- 1Department of Obstetrics and Gynecology, King Abdul Aziz University, Jeddah, Saudi Arabia.
Abstract
Background
Rectus sheath closure is a modifiable factor for incisional hernia, wound dehiscence, and surgical site infection. Guidelines recommend continuous small-bites closure using a slowly absorbable monofilament suture with a suture to wound length (SL:WL) ratio of at least 4:1. However, few data are available from obstetrics and gynecology, which is the specialty with the largest number of abdominal closures worldwide.Methods
A cross-sectional survey was conducted among 58 surgeons with various levels of training and specialties to assess rectus sheath closure techniques, self-reported complications, and attitudes toward changing practice. Chi-square, Fisher's exact, and Mann-Whitney tests were used to compare professional levels. Predictors of complication occurrence were identified using logistic regression.Results
Most participants were obstetricians and gynecologists (84.48%) working in academic hospitals (72.41%). Only 5.17% achieved the recommended SL:WL ratio ≥4:1, whereas 29.31% reported a ratio of 1:1 and 18.97% adhered to no specific ratio. The mean bite size (0.87 cm) and inter-suture distance (0.98 cm) were approximately double the recommended standard of 5 mm. Two-thirds (67.24%) used both monofilament and braided sutures despite the recommendation to only use monofilament. Self-reported incidence of hernia (1.72%) was lower than prospective estimates (11-30%). Surgeons with 6-10 years of experience had significantly higher odds of reporting complications than those with >15 years (odds ratio = 33.54; 95% confidence interval = 1.42-1724.32; p = 0.041). Despite widespread non-compliance, 74.14% expressed high willingness to change their practice, and lack of training was identified as the primary barrier (36.21%).Conclusion
Surgeons, mainly obstetricians and gynecologists, significantly deviated from the recommended rectus sheath closure techniques. The high level of non-compliance and willingness to change suggested a lack of infrastructure and training, and structured educational interventions were identified as a priority target.
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BibTeX
@article{shamrani2026current,
title = {{Current practices and attitudes toward rectus sheath closure among surgeons: A cross-sectional study.}},
author = {Hanan M Shamrani and Sarah Qari},
journal = {Journal of Taibah University Medical Sciences},
year = {2026},
month = oct,
doi = {10.1016/j.jtumed.2026.09.011},
url = {https://europepmc.org/article/MED/42909382},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Current practices and attitudes toward rectus sheath closure among surgeons: A cross-sectional study.
AU - Hanan M Shamrani
AU - Sarah Qari
PY - 2026
DA - 2026/10/13
JO - Journal of Taibah University Medical Sciences
DO - 10.1016/j.jtumed.2026.09.011
UR - https://europepmc.org/article/MED/42909382
AB - Background Rectus sheath closure is a modifiable factor for incisional hernia, wound dehiscence, and surgical site infection. Guidelines recommend continuous small-bites closure using a slowly absorbable monofilament suture with a suture to wound length (SL:WL) ratio of at least 4:1. However, few data are available from obstetrics and gynecology, which is the specialty with the largest number of abdominal closures worldwide.Methods A cross-sectional survey was conducted among 58 surgeons with various levels of training and specialties to assess rectus sheath closure techniques, self-reported complications, and attitudes toward changing practice. Chi-square, Fisher's exact, and Mann-Whitney tests were used to compare professional levels. Predictors of complication occurrence were identified using logistic regression.Results Most participants were obstetricians and gynecologists (84.48%) working in academic hospitals (72.41%). Only 5.17% achieved the recommended SL:WL ratio ≥4:1, whereas 29.31% reported a ratio of 1:1 and 18.97% adhered to no specific ratio. The mean bite size (0.87 cm) and inter-suture distance (0.98 cm) were approximately double the recommended standard of 5 mm. Two-thirds (67.24%) used both monofilament and braided sutures despite the recommendation to only use monofilament. Self-reported incidence of hernia (1.72%) was lower than prospective estimates (11-30%). Surgeons with 6-10 years of experience had significantly higher odds of reporting complications than those with >15 years (odds ratio = 33.54; 95% confidence interval = 1.42-1724.32; p = 0.041). Despite widespread non-compliance, 74.14% expressed high willingness to change their practice, and lack of training was identified as the primary barrier (36.21%).Conclusion Surgeons, mainly obstetricians and gynecologists, significantly deviated from the recommended rectus sheath closure techniques. The high level of non-compliance and willingness to change suggested a lack of infrastructure and training, and structured educational interventions were identified as a priority target.
SN - 1658-3612
ER -