Does the peritoneum need to be closed at laparotomy?

Closure of vertical laparotomy wounds was randomized between a two-layer technique of continuous catgut to peritoneum and continuous nylon to sheath and a one-layer technique in which the peritoneal suture line was omitted. In 162 two-layer closures there were 4 burst abdomens and 7 wound hernias (6.8 per cent wound failures); in 164 one-layer closures there were 5 burst abdomens and 7 hernias (7.3 per cent failures). Of 21 patients in this series with jaundice, the abdominal wounds dehisced in 3, and 4 patients developed incisional hernias (33.3 per cent failures) compared with a 5.2 per cent failure rate in the 305 non-jaundiced patients (P less than 0.01). Closure of the peritoneum as a separate layer, as widely advised and practised, appears to play no significant role in the healing of the laparotomy wound.