Fascial closure in midline laparotomy involves approximating the linea alba using a continuous or interrupted technique, typically with a slowly absorbable or non-absorbable suture (e.g., loop PDS or nylon). The key principle is a "small bites" technique - taking 5-8mm tissue bites at 5mm intervals, achieving a suture length to wound length ratio of at least 4:1. Mass closure (all layers except skin) through the full thickness of the abdominal wall is preferred over layered closure for most midline wounds.

The primary source is Fischer's Mastery of Surgery. Let me read that block comprehensively.

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