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Lesch et al. Mini-invasive Surg 2023;7:20 https://dx.doi.org/10.20517/2574-1225.2023.24 Page 7 of 8

CONCLUSION
Secure closure of median abdominal wall incisions is achievable with sutures regardless of small or large bite
technique and material thickness. But as can be seen from the GRIP/CRIP concept, larger defects require
more complex reconstruction. For larger defects, suture closure alone may not be sufficient, depending on
the circumstances. A larger impact area, for example, lowers the durability. This experimental study
revealed that Monomax® sutures provide a higher level of closure security than PDS® sutures. The thickness
of the suture showed no difference. It is advisable to choose the safest suture technique and mesh
reinforcement in larger abdominal wall defects.

DECLARATIONS
Acknowledgments
We thank the financial support by the Heidelberger Stiftung Chirurgie (grants 2016/ 22, 2017/ 171, 2018/
215, 2019/ 288, 2020/ 376, and 2021/ 444).

Authors’ contributions
Performed the data analysis and wrote the article: Lesch C
Performed the experiments: Kugel F, Uhr K
Lead the construction of the bench test and its maintenance: Vollmer M
Contributed important thoughts and discussions for the construction of the experiments and the paper:
Nessel R
Closely guided the execution of the experiments, designed parts of the experiments, and continuously
supervised the paper: Kallinowski F
Designed parts of the experiments and proofread the paper: Fortelny RH

Availability of data and materials
The raw data supporting the conclusions of this article will be made available by the authors, without
reservation.

Financial support and sponsorship
We thank the financial support by the Heidelberger Stiftung Chirurgie (grants 2016/ 22, 2017/ 171, 2018/
215, 2019/ 288, 2020/ 376, and 2021/ 444).
Disclaimer FK received financial and material support from Baxter, Becton Dickinson, Corza, Dahlhausen,
Ethicon, FEG, GEM, Medtronic, Olympus, and PFM medical based on a Third-Party-Funding-Agreement
with the Heidelberg University and / or with Asklepios proresearch. Fortelny RH. Received speaker's
honorarium by B.Braun, Becton Dickinsin, and Medtronic and research grants by the Wiener
Gesundheitsverbund, Klinik Ottakring, 523403.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
The research was conducted after building a bench test for low cyclic loading of tissues. Human material
was not used. Accordingly, no informed consent from patients was required. The ethical approval to use
animal tissues was given by local authorities according to European law with the permission DE 08 221
1018.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2023.