Small Bites Versus Large Bites for Closure of Midline Abdominal Incisions: A Systematic Review and Meta-Analysis With
Anfal Alrashidi1, Ahmed W Hageen2, Mohamed Rifai3
1College of Medicine, Qassim University, Buraydah, Saudi Arabia.
Background:
Incisional hernia is a common and significant complication following midline laparotomy, often leading to substantial morbidity, reduced quality of life, and increased healthcare costs. This study aims to evaluate and compare small bites versus large bites for closure of midline abdominal incisions.
Methods:
We conducted a comprehensive systematic review and meta-analysis of RCTs from PubMed, Web of Science, Scopus, Embase, and Cochrane searches until 15 December 2024. Dichotomous data were pooled using risk ratio (RR), and continuous data were pooled using mean difference (MD), both with a 95% confidence interval (CI), using (R version 4.3).
Results:
Our analysis included seven RCTs encompassing 2299 patients. Compared to the large bites, small bites group was associated with a reduced incidence of ventral incisional hernia (VIH) (RR: 0.46 with 95% CI [0.35: 0.60]. p value > 0.01), and surgical site infection (SSI) (RR: 0.73 with 95% CI [0.58: 0.92], p value > 0.01). However, there was no significant difference between the two groups in all-cause mortality (RR: 0.70 with 95% CI [0.47: 1.06], p value = 0.09), burst abdomen (RR: 0.72 with 95% CI [0.11: 0.84], p value = 0.73), anastomotic leak (RR: 0.62 with 95% CI [0.20: 1.99], p value = 0.43), and ileus (RR: 0.68, 95% CI [ 0.54: 1.36], p value = 0.51). Finally, the small bites group was associated with a significant decrease in length of hospital stay (MD: -1.03, 95% [-1.72: -0.33], p value > 0.01).
Conclusion:
Small bites suture technique for fascial closure in midline laparotomies significantly reduces the incidence of VIH and SSI compared to the large bites technique. Additionally, the small bites technique is associated with a shorter length of hospital stay without affecting the overall mortality. These findings suggest that the small bites technique may offer superior outcomes in reducing certain postoperative complications and improving recovery times, making it a preferable option for midline laparotomy closures.
