Open laparotomy requires closure of 4 layers from the inside out. Layer 1: the mural peritoneum, which requires continuous suturing to close the peritoneal cavity and thus avoid incisional hernias. Layer 2: tendon and muscle layers, such as the right lower abdominal incision which often requires closure of the internal oblique, rectus abdominis, transverse abdominis and external oblique abdominal muscles, requiring interrupted sutures to achieve reinforcement of the local muscle layers. Layer 3: subcutaneous fascial layer, commonly campers fascia and scarpa fascia, which is closed to allow gradual wound reduction and avoid the occurrence of subcutaneous tissue dead space. Layer 4: the skin layer, which requires interrupted sutures or cosmetic sutures in order to achieve closure.