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The double loop suture is run in a continuous manner taking full thickness of the linea alba fascia and peritoneum on either side of the incision (Figure 17). After placement of the final stitch superiorly, the needle is cut off and one limb of the suture retracted back across the incision. This allows the two cut ends to be tied along one side of the incision.
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Some surgeons prefer to use the figure-of-eight, or so-called eight-pound stitch, when closing fascia with the interrupted sutures. A full-thickness horizontal bite is taken that enters the linea alba on the far side at A and exits at B (Figure 18). The suture is advanced for a centimeter or two, and an additional transverse full-thickness bite is taken that enters at C and exits at D. When the two ends of the suture are tied, a crisscrossing, horizontal figure-of-eight is created (Figure 19). The knot should be tied to one side. In general, the figure-of-eight suture is placed snugly rather than tightly where it may cut through the tissue with any postoperative swelling.
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After each knot is tied during the closure, the ends of the suture are held under tension by the assistant and are cut. Silk sutures may be cut within 2 mm of the knot, whereas many absorbable or synthetic sutures require several millimeters be left, as the knots may slip. As the suture is held nearly perpendicular to the incision by the assistant, the scissors are slid down to the knot and rotated a quarter turn (Figures 20 and 21). Closure of the scissors at this level allows the suture to be cut near the knot without destroying it. In general, the scissors are only opened slightly such that the cutting occurs near the tips. Additional fine control of the scissors may be obtained by supporting the mid portion of the scissor on the outstretched index and middle fingers ...