SynthesisColorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland2025
Small-bites versus large-bites closure of midline laparotomies: A systematic review and meta-analysis.
Synthesis in Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 3 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
6 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Robotic versus laparoscopic TME for rectal cancer: meta-analysis of pathological quality indicators.Techniques in coloproctology · 2026Pooled it
- Impact of the SUture BIte TEchnique on clinical outcomes after midline laparotomy closure: SUBITE-a systematic review and meta-analysis.Hernia : the journal of hernias and abdominal wall surgery · 2026Pooled it
- Small-bites versus large-bites closure of midline laparotomies: A systematic review and meta-analysis.Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland · 2025Pooled it
- Barbed Sutures Are Associated With a Lower Incidence of Incisional Hernia Compared With Continuous Non-Barbed Monofilament Sutures After Minimally Invasive Gastroenterological Surgery.Annals of gastroenterological surgery · 2026Article
- Enhanced view/extended totally extraperitoneal plasty (eTEP) Rives-Stoppa repair versus open Rives-Stoppa repair: a single-center retrospective propensity score-matched cohort study.Surgical endoscopy · 2026Article
- Incisional hernia and the risk of incident depression: a population-based propensity score-matched cohort study.Hernia : the journal of hernias and abdominal wall surgery · 2026Article
Corrections and comments
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimSurgical 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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.