Small‐bites versus large‐bites closure of midline laparotomies: A systematic review and meta‐analysis
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| Format: | Artículo Open Access |
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Wiley
2025
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| author | Stefan Morarasu Sorinel Lunca Luke O'Brien Paul Lynch Ana Maria Musina Cristian Ene Roata Raluca Zaharia Wee Liam Ong Gabriel‐Mihail Dimofte Cillian Clancy |
| author_facet | Stefan Morarasu Sorinel Lunca Luke O'Brien Paul Lynch Ana Maria Musina Cristian Ene Roata Raluca Zaharia Wee Liam Ong Gabriel‐Mihail Dimofte Cillian Clancy Stefan Morarasu Sorinel Lunca Luke O'Brien Paul Lynch Ana Maria Musina Cristian Ene Roata Raluca Zaharia Wee Liam Ong Gabriel‐Mihail Dimofte Cillian Clancy |
| collection | Wiley Open Access |
| contents | Small‐bites versus large‐bites closure of midline laparotomies: A systematic review and meta‐analysis Stefan Morarasu Sorinel Lunca Luke O'Brien Paul Lynch Ana Maria Musina Cristian Ene Roata Raluca Zaharia Wee Liam Ong Gabriel‐Mihail Dimofte Cillian Clancy Colorectal Disease AbstractAimSurgical site infection (SSI) and incisional hernia (IH) are common complications following midline laparotomy. The small‐bites technique for closing a midline laparotomy has been suggested to improve SSI and IH rates compared with the classic mass closure. The aim of this work was to perform a systematic review, meta‐analysis and fragility assessment of existing evidence comparing small‐bites and conventional closure.MethodThe study was registered with PROSPERO. A systematic search of PubMed and EMBASE databases was performed for all comparative studies examining small‐bites versus conventional closure for midline laparotomy. The fragility index for randomized controlled trials (RCTs) was assessed and the number of outcomes required to render results insignificant using the Fisher exact test was calculated.ResultsSeven studies were included, with a total of 3807 patients. Small bites was performed in 1768 and large bites in 2039. Follow‐up ranged from 12 to 52 months. On meta‐analysis of all studies, small bites is associated with a lower risk of IH (p < 0.00001), SSI (p = 0.0002) and wound dehiscence (p = 0.02). On meta‐analysis of RCTs there is a lower risk of IH (p = 0.01) but no difference in SSI (p = 0.06) or wound dehiscence (p = 0.73). Fragility is evident among RCTs reporting differences in IH rates.ConclusionThere is evidence to suggest that small‐bites closure provides a decreased likelihood of IH over varying follow‐up in RCTs but significant fragility exists among studies. 10.1111/codi.70073 http://creativecommons.org/licenses/by/4.0/ |
| doi_str_mv | 10.1111/codi.70073 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_codi_70073 |
| institution | Wiley Open Access |
| license_str_mv | http://creativecommons.org/licenses/by/4.0/ |
| publishDate | 2025 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Small‐bites versus large‐bites closure of midline laparotomies: A systematic review and meta‐analysis Stefan Morarasu Sorinel Lunca Luke O'Brien Paul Lynch Ana Maria Musina Cristian Ene Roata Raluca Zaharia Wee Liam Ong Gabriel‐Mihail Dimofte Cillian Clancy Colorectal Disease Small‐bites versus large‐bites closure of midline laparotomies: A systematic review and meta‐analysis Stefan Morarasu Sorinel Lunca Luke O'Brien Paul Lynch Ana Maria Musina Cristian Ene Roata Raluca Zaharia Wee Liam Ong Gabriel‐Mihail Dimofte Cillian Clancy Colorectal Disease AbstractAimSurgical site infection (SSI) and incisional hernia (IH) are common complications following midline laparotomy. The small‐bites technique for closing a midline laparotomy has been suggested to improve SSI and IH rates compared with the classic mass closure. The aim of this work was to perform a systematic review, meta‐analysis and fragility assessment of existing evidence comparing small‐bites and conventional closure.MethodThe study was registered with PROSPERO. A systematic search of PubMed and EMBASE databases was performed for all comparative studies examining small‐bites versus conventional closure for midline laparotomy. The fragility index for randomized controlled trials (RCTs) was assessed and the number of outcomes required to render results insignificant using the Fisher exact test was calculated.ResultsSeven studies were included, with a total of 3807 patients. Small bites was performed in 1768 and large bites in 2039. Follow‐up ranged from 12 to 52 months. On meta‐analysis of all studies, small bites is associated with a lower risk of IH (p < 0.00001), SSI (p = 0.0002) and wound dehiscence (p = 0.02). On meta‐analysis of RCTs there is a lower risk of IH (p = 0.01) but no difference in SSI (p = 0.06) or wound dehiscence (p = 0.73). Fragility is evident among RCTs reporting differences in IH rates.ConclusionThere is evidence to suggest that small‐bites closure provides a decreased likelihood of IH over varying follow‐up in RCTs but significant fragility exists among studies. 10.1111/codi.70073 http://creativecommons.org/licenses/by/4.0/ |
| title | Small‐bites versus large‐bites closure of midline laparotomies: A systematic review and meta‐analysis |
| topic | Colorectal Disease |
| url | https://onlinelibrary.wiley.com/doi/10.1111/codi.70073 |