Small bite versus large bite stitching technique for midline laparotomy wound closure: A systematic review and...

Area of Science:

• Surgical Innovation
• Wound Healing
• Meta-Analysis

Background:

• Midline laparotomy closures traditionally use mass closure with large bite stitching.
• Emerging evidence suggests small bite techniques may lower complication rates like incisional ventral hernia and surgical site infection (SSI).

Approach:

• A meta-analysis was performed comparing small bite versus large bite stitching techniques for midline laparotomy wound closure.
• Data from five randomized controlled trials (RCTs) and three prospective cohort studies were analyzed, including 1977 participants.
• Outcomes assessed included incisional ventral hernia, SSI, and burst abdomen rates.

Key Points:

• The small bite stitch technique demonstrated a significant reduction in incisional ventral hernia (OR 0.39) and SSI (OR 0.68).
• A trend towards reduced burst abdomen incidence was observed with the small bite technique (OR 0.60).
• The analysis included 961 patients in the small bite group and 1016 in the large bite group.

Conclusions:

• Small bite stitch technique appears superior to the conventional large bite technique for midline laparotomy wound closure.
• This superiority is evidenced by statistically significant lower rates of incisional ventral hernia and SSI.
• Further research may explore the trend towards reduced burst abdomen rates.