Absorbable monofilament suture for Abdominal Wall Closure

Monomax® is the unique suture in the market made of poly-4-hydroxibutyrate.

  • Extra-long term absorption, Monomax loses its relative tensile strength slower than polydioxanone sutures (slower tensile strength degradation profile compared to polydioxanone sutures). [1,2,3]
  • Elasticity and elongation: Monomax® elongates twice as much as polydioxanone sutures. [4]
  • Sizes available USP 2/0 (metric 3) up to USP 1 (metric 4).
  • It degrades by hydrolysis and enzymatic reaction.

Using Monomax® low incisional hernia rates were observed independent of the stitch technique used for abdominal wall closure. [5]

A unique suture

Maximum Elongation

Monomax® elongates twice as much as polydioxanone sutures. [4]

Monomax® has peak values of elongation more than double the elongation values of PDS® II. According to the basic assumption that a more elongable suture material should have a positive impact on the tissue strangulation, Monomax® can follow peak loads (during coughing, movements, etc.) easier than PDS® II.
The latter one is rather rigid already beginning at low forces which might disturb the blood supply to the sutured tissues. [4]


The major long term complication of abdominal wall closure after a median laparotomy is the development of an incisional hernia. Synthetic suture material which have become available over the last decades have the advantage that they are degraded by the body system and fully absorbed within 70-180 days; however they loss 50% of their initial strength already after 14-30 days and may not be the optimal suture material for abdominal wall closure. A new suture material (Monomax®) was developed with an extra-long absorption profile, high elasticity and with a superior initial strength. Therefore, the ESTOIH-Study was designed to investigate the influence of the stitch length on the occurrence of incisional hernia using the extra-long term absorbable, elastic, monofilament suture (Monomax®). [8]

Find the link to the publication:
Effects of the Short Stitch Technique for Midline Abdominal Closure on Incisional Hernia (ESTOIH): Randomized Clinical TrialRead more on PubMed >>
Effects of the short-stitch technique for midline abdominal closure: short-term results from the randomised-controlled ESTOIH trialRead more on PubMed >>

ESTOIH study results

If you missed our Digital Dialog of Incisional Hernia Prevention and ESTOIH study results celebrated last June 2022 you can also watch the recording on Aesculap Academy website. This digital course was conducted by Prof. Fortelny, general and visceral surgeon specialized in hernia surgery at the Confraternitaet Private Hospital & Sigmund Freud Private University in Vienna. He is the Principal Investigator of ESTOIH study.

Register now to watch the video under the section Hernia Repair

Short stitches technique video

In addition to the suture material, the technique plays an important role in the reduction of postoperative complications.

Monomax® in Laparoscopy

Monomax® with hook needles for laparoscopic procedures.

The use of Monomax® is adequate for fascia closure in open or in laparoscopic procedures. [9,10]
Literature reports the need to use a slowly-absorbable or even non-absorbable suture to prevent trocar site hernias. [11]
Monomax® possibly reduces the incidence of incisional hernias in comparison to polypropylene sutures (in 2 years follow-up). [12]