Small-Bite Versus Large-Bite Closure for the Prevention of Incisional Hernia: A Meta-Analysis.

Area of Science:

• Surgical Innovation
• Abdominal Surgery
• Hernia Repair

Background:

• Incisional hernias are a common complication after midline laparotomy, causing significant patient morbidity and increased healthcare costs.
• Fascial closure technique is a modifiable factor influencing hernia development.
• The small-bite (short stitch) technique is proposed as superior to the traditional large-bite (long stitch) method.

Purpose of the Study:

• To systematically evaluate and compare the effectiveness of small-bite versus large-bite fascial closure in preventing incisional hernias.
• To assess the impact of these techniques on related wound complications such as surgical site infection and wound dehiscence.

Main Methods:

• A meta-analysis was conducted following PRISMA guidelines, searching major databases for randomized controlled trials and prospective comparative studies.
• Studies published up to December 2025 involving adult patients undergoing midline laparotomy were included.
• Data were pooled using a random-effects model, with outcomes including incisional hernia, surgical site infection (SSI), and wound dehiscence.

Main Results:

• The small-bite closure technique was associated with a significantly reduced risk of incisional hernia (OR: 0.49, 95% CI: 0.33-0.73).
• This technique also significantly decreased the risk of surgical site infection (OR: 0.45, 95% CI: 0.31-0.66) and wound dehiscence (OR: 0.42, 95% CI: 0.26-0.69).
• Low to moderate heterogeneity was observed across the analyzed outcomes.

Conclusions:

• Small-bite fascial closure is a demonstrably effective strategy for reducing incisional hernias after midline laparotomy.
• The small-bite technique also significantly lowers the incidence of surgical site infections and wound dehiscence.
• Routine adoption of the small-bite technique is recommended as a simple, cost-effective method to enhance postoperative surgical outcomes.