Morarasu Stefan, Lunca Sorinel, O'Brien Luke, Lynch Paul, Musina Ana Maria, Roata Cristian Ene, Zaharia Raluca, Ong Wee Liam, Dimofte Gabriel-Mihail, Clancy Cillian
2nd Department of Surgical Oncology, Regional Institute of Oncology (IRO), Iasi, Romania.
Grigore T Popa University of Medicine and Pharmacy Iasi, Iasi, Romania.
Colorectal Dis. 2025 Mar;27(3):e70073. doi: 10.1111/codi.70073.
Surgical 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.
The 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.
Seven 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.
There 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.
手术部位感染（SSI）和切口疝（IH）是中线剖腹术后常见的并发症。与传统的整块缝合相比，有人提出采用小切口技术关闭中线剖腹术可提高SSI和IH的发生率。本研究的目的是对比较小切口缝合与传统缝合的现有证据进行系统评价、荟萃分析和脆弱性评估。
本研究已在国际前瞻性系统评价注册库（PROSPERO）登记。对PubMed和EMBASE数据库进行系统检索，以查找所有比较小切口与传统缝合用于中线剖腹术的对照研究。评估随机对照试验（RCT）的脆弱性指数，并计算使用Fisher精确检验使结果无统计学意义所需的结局数量。
纳入7项研究，共3807例患者。1768例行小切口缝合，2039例行大切口缝合。随访时间为12至52个月。对所有研究进行荟萃分析，小切口缝合与较低的IH风险（p<0.00001）、SSI风险（p=0.0002）和伤口裂开风险（p=0.02）相关。对RCT进行荟萃分析，IH风险较低（p=0.01），但SSI（p=0.06）或伤口裂开（p=0.73）无差异。在报告IH发生率差异的RCT中，脆弱性明显。
有证据表明，在RCT中，小切口缝合在不同随访期内发生IH的可能性降低，但各研究之间存在明显的脆弱性。
