Slowly absorbable sutures do not increase the risk of reoperation for recurrence compared with nonabsorbable sutures in primary ventral hernia repair: A nationwide register-based cohort study

BACKGROUND: Primary ventral hernias are common, and the choice of suture material may influence the risk of recurrence. This study investigated the risk of reoperation for recurrence following primary ventral hernia repair using slowly absorbable or fast-absorbable sutures compared with nonabsorbable sutures. METHODS: This study used prospectively collected data from the Danish Ventral Hernia Database (2007-2024). Data were linked with the Danish National Patient Register and the Danish Civil Registration System to ensure complete follow-up. We included patients with primary ventral hernias (umbilical and epigastric) with a defect width ≤4 cm, stratified into suture-only and onlay mesh cohorts. RESULTS: We included 31,189 patients, and suture-only repairs accounted for 68% (n = 21,202) of cases, while onlay mesh repairs accounted for 32% (n = 9,987). In the suture-only cohort, there was no difference in reoperation risk for slowly absorbable sutures (hazard ratio 1.02, 95% confidence interval 0.88-1.19, P = .768) or fast-absorbable sutures (1.16, 0.93-1.45, P = .184) compared with nonabsorbable sutures. Similarly, in the onlay mesh cohort, no difference was found for slowly absorbable (hazard ratio 1.19, 95% confidence interval 0.83-1.67, P = .355) or fast-absorbable sutures (0.80, 0.20-3.23, P = .754). CONCLUSION: Slowly absorbable sutures did not increase the risk of reoperation compared with nonabsorbable sutures, regardless of mesh use. Although no significant difference was found between nonabsorbable and fast-absorbable sutures, this should be interpreted with caution because of limited data. These findings suggest that slowly absorbable sutures are a safe option and may be preferred because of complications associated with nonabsorbable sutures.