Suture Technique for Fascial Closure in Midline Laparotomy in Patients at High Risk of Post-surgical Evisceration.

The objective of this study is to describe the modified Maingot keel closure technique as a reinforced fascial closure strategy in patients at high risk of postoperative evisceration and to report the short-term clinical outcomes associated with its application. We present a case series of four patients undergoing midline laparotomy who were considered at high risk for postoperative fascial dehiscence according to a Van Ramshorst score greater than 6. The modified Maingot keel closure technique was performed as primary or secondary fascial reinforcement according to the clinical scenario. Four patients (three women and one man) older than 50 years were included. The Van Ramshorst scores ranged from 7 to 9. The mean operative time was approximately three hours. No intraoperative complications, postoperative evisceration, surgical reintervention, or wound-related complications were observed during follow-up. The mean hospital stay was 4.5 days. The modified Maingot keel closure technique was technically feasible and was associated with favorable short-term outcomes in this selected group of high-risk patients. However, due to the limited sample size and absence of a comparison group, these findings should be interpreted cautiously. Prospective comparative studies with larger populations and longer follow-up are required to determine its definitive role in abdominal wall closure strategies.