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      Optimal Outcomes with Small Bite Technique and Monomax®

      Abdominal wall closure with Monomax®

      Achieve optimal surgical outcomes with the small bite technique. Join our exclusive Monomax® webinar and learn from experts like Prof. Dr. Fortelny about the benefits of using Monomax® in midline closure techniques for better results in daily surgical practice when it comes to reducing incisional hernia rates.

      A line drawing of a female surgeon holding a suture with a needle clamp. The suture forms the claim “Monomax for abdominal wall closure – as reliable as you” below the drawing.

      On this page

      Abdominal Wall Closure

      Redefining abdominal wall closure with Monomax®

      Prof. Dr. med. René H. Fortelny, Chair General Surgery Sigmund Freud Private University Vienna, explains a young surgeon why using the small bite technique with Monomax® will reduce incisional hernia and substantially lead to better results in daily situations in the OR. His recommendation: The use of small bites with Monomax® should be performed in all midline closure techniques even when a prophylactic mesh has been used.[1, 2, 3]

      As durable as you

      Extra-long tensile strength retention for a safe long-healing process [4].

      As flexible as you

      Extra elastic & pliable suture to support intra-abdominal pressure changes [5].

      As reliable as you

      The distinctive properties of Monomax® play a role to reduce hernia rates in comparison with the use of polidioxanone sutures [6].

      As unique as you

      Monomax® is the first and unique extra-long term monofilament suture [7].

      Portrait of Professor Doctor René Fortelny in business attire looking confidently into the camera

      “Using the small bite technique with Monomax® will reduce incisional hernia and significantly lead to better results in daily situations in the OR. The right technique in combination with the right product is essential to achieve success.”

      Prof. Dr. René Fortelny, Chair General Surgery Sigmund Freud Private University Vienna

      Exclusive Monomax® Webinar

      How to master abdominal wall closure

      Want to learn more about Monomax® and how to optimize abdominal wall closure? Then sign up now for the exclusive live webinar “Incisional Hernia Prevention” with Prof. Dr. Fortelny and improve your skills in midline laparotomy closure to help incisional hernia prevention.

      Two hands holding a tablet showing a scene of the Redefining abdominal wall closure with Monomax® with the text overlay as flexible as you

      Title: How to master abdominal wall closure
      Date: April 30, 2025
      Time: 4:00 PM - 5:30 PM UTC+1

      Main session: Incisional hernia prevention

      • Update on latest evidence in prevention.
      • Effect of suture technique on the occurrence of incisional hernia. After elective midline abdominal wall closure (ESTOIH trial). Presentation of 1, 3 and 5 year follow-up results.
      • Safe use of Monomax® in daily clinical routine.
      • Videos session: How to perform the Abdominal wall opening & closure.
      • Short stitches with Monomax®. 
      • Tips & Tricks.

      Round table discussion: Expertise from senior surgeons and legacy to the young generations coming

      Questions & Answers

      Sign up now

      Clinical evidence Monomax®

      Study Overview

      According to the ESTOIH study results the combination of Monomax® with small bite results in 4,2% of incisional hernia after one year follow-up. This is much lower than in other studies with other sutures.

      Learn more
      a selfie of Medical Student Sara Cama in surgical clothing smiling into the camera

      “Monomax® handles abdominal pressure with ease, ensuring successful midline closure in any situation.”

      Sara Cama, Medical Student, Universitat Internacional de Catalunya, Barcelona

      Small bite technique & Monomax® – the winning team

      Monomax® low rates of incisional hernia are observed regardless of the stitch technique. Combining both – Monomax(R) and small bite technique – you may expect the best results [3, 6, 8].

      Portrait of Professor Javier López Monclús in a docotor‘s coat smiling confidently into the camera

      “Monomax is my suture of choice for the closure of subcostal laparotomies in liver transplant patients.”

      Prof. Javier López Monclús, Specialist Physician in the Hepatobiliopancreatic Surgery and Liver Transplant Unit, University Hospital Puerta de Hierro Majadahonda, Madrid, Spain

      Extra long-term absorption and maximum elongation

      Monomax® is the first and unique extra long-term absorbable monofilament synthetic suture material. It loses its relative tensile strength slower than polydioxanone sutures (slower tensile strength degradation profile compared to polydioxanone sutures – in vivo data).[9]

      Learn more
      Portrait of Professor Doctor Markus Golling in a docotor‘s coat smiling confidently into the camera

      “Monomax is a unique biologic thread. It handles extremely well intraoperatively, has one of the strongest tensile properties of all resorbable sutures, yet disciplines the user by giving an undeniable visual feedback on misuse!”

      Prof. Dr. med. Markus Golling, FRCSI, Chairman General- & Visceral Surgery, Das DIAK, DIAKONEO, Teaching Hospital University of Heidelberg, Germany

      Get in touch with our experts

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      I can revoke my consent at any time by sending an e-mail to info(@)aesculap.de or by clicking on the unsubscribe link at the end of any marketing e-mail. For more information about the processing of your data and your data protection rights, please refer to our privacy notice.

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      References

      1. Hoer J., Lawong G., Klinge U., Schumpelick V. Factors influencing the development of incisional hernia. A retrospective study of 2,983 laparotomy patients over a period of 10 years. Chirurg. 2002;73(5):474–480. 
      2. Alnassar S, Bawahab M, Abdoh A, Guzman R, Al Tuwaijiri T, Louridas G (2012) Incisional hernia postrepair of abdominal aortic occlusive and aneurysmal disease: five-year incidence. Vascular 20:273–277
      3. Fortelny R.H., Andrare D., Schirren M., Baumann P., Riedl S., Reisensohn C. et al. Effects of the Short Stotch Technique for Midline Abdominal Closure on Incisional Hernia (ESTOIH): Randomized Clinical Trial. BJS, 2022 Aug; 109(9):839-845.
      4. Data on files Lab No. 3080, 04200, 3450, 4198.
      5. Data on file RDR/DID/MON/MAU/13118
      6. Fortelny R.H., Hofmann A., Baumann P., Riedl S., Kewer J.L., Hoelderle J. et al. Three-year follow-up analysis of the short-stitch versus long-stitch technique for elective midline abdominal closure randomized-controlled (ESTOIH) trial. Hernia. 2024 Aug;28(4):1283-1291.
      7. Covered by patent EP 1638615 B1 (Polyhydroxyalkanoate medical textiles and fibers).
      8. Deerenberg E.B, Henriksen N.A., Antoniou G.A., Antoniou, Wichor M Bramer, John P Fischer, et al. Updated guideline for closure of abdominal wall incisions from the European and American Hernia Societies, British Journal of Surgery, Volume 109, Issue 12, December 2022, Pages 1239–1250.
      9. Data on file FRM/PNT/22/OP/027/02.

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