Evidence map›Paper›PMID 42077687›Full record

ReviewCureus2026

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

Sadaf Khalid, Mohammed Balbola, Rimsha Rana, Ifiok Archibong, Abil Ansari, Zain Zafar

Abstract readReview
In one paragraph

Review in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Sadaf KhalidMedicine, Medway Maritime Hospital NHS Trust, Gillingham, GBR.
Mohammed BalbolaSurgery, Kent, Surrey and Sussex, Kent, GBR.
Rimsha RanaGeneral Surgery, Royal Free NHS Foundation Trust Barnet Hospital, London, GBR.
Ifiok ArchibongSurgery, Maidstone Tunbridge Wells Hospital, Kent, GBR.
Abil AnsariGeneral and Colorectal Surgery, Medway Maritime NHS Foundation, Kent, GBR.
Zain ZafarMedicine, Maidstone Tunbridge Wells Hospital, Kent, GBR.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Incisional hernia remains a common and clinically significant complication following midline laparotomy, contributing to patient morbidity, impaired quality of life, and increased healthcare costs. The fascial closure technique has been recognized as a potentially modifiable factor influencing hernia development. In recent years, the small-bite (short stitch) technique has been proposed as superior to the traditional large-bite (long stitch) method. This meta-analysis aimed to systematically evaluate and compare the effectiveness of small-bite versus large-bite fascial closure in preventing incisional hernia and related wound complications. A comprehensive literature search of PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, ProQuest, and Google Scholar was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify comparative studies published from inception to December 2025. Randomized controlled trials (RCTs) and prospective comparative studies involving adult patients undergoing midline laparotomy were included. The primary outcome was incisional hernia, while secondary outcomes included surgical site infection (SSI) and wound dehiscence. Data were pooled using a DerSimonian-Laird random-effects model, and results were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the I² statistic. Five studies comprising diverse elective and emergency surgical populations were included in the quantitative synthesis. Small-bite closure was associated with a significantly reduced risk of incisional hernia compared with large-bite closure (pooled OR: 0.49, 95% CI: 0.33-0.73; p = 0.0004), with low to moderate heterogeneity (I² = 37%). Additionally, small-bite closure significantly decreased the risk of surgical site infection (pooled OR: 0.45, 95% CI: 0.31-0.66; p < 0.0001; I² = 18%) and wound dehiscence (pooled OR: 0.42, 95% CI: 0.26-0.69; p = 0.0006; I² = 41%). Across all outcomes, the direction of effect consistently favored the small-bite technique. This meta-analysis demonstrates that small-bite fascial closure significantly reduces the risk of incisional hernia, surgical site infection, and wound dehiscence following midline laparotomy. These findings support the routine adoption of the small-bite technique as a simple, cost-effective strategy to improve postoperative outcomes.

Indexed as

incisional hernialarge-bite closuremeta-analysismidline laparotomysmall-bite closure

Identifiers

PMID42077687
PMCPMC13129482

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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.