A new study provides compelling evidence for adopting the small-bites fascial closure technique to reduce long-term incisional hernia rates after elective midline laparotomy.
Conducted across 10 Dutch centres, the multicentre randomised trial followed 559 patients for a median of eight years.
It reveals that the small-bites method significantly reduces both the incidence and the size of hernias compared with traditional large-bite closure.
The trial’s primary outcome showed a 15% absolute reduction in hernia formation at 13 years – 34% in the small-bites group versus 49% in the large-bites cohort.
Additionally, hernias in the small-bites group tended to be smaller at final assessment, averaging 25mm compared with 43mm in the large-bites group.
These findings underscore the long-term benefits of small-bite fascial closure, which not only reduces hernia incidence but also leads to fewer patients experiencing hernia-related complications.
Notably, hernia repair rates did not differ significantly between groups, suggesting that smaller hernias may be easier and less invasive to repair when required.
Patients who developed hernias reported lower quality of life, underscoring the importance of preventive strategies.
The small-bites method, characterised by 5mm by 5mm polydioxanone sutures, is straightforward and cost-neutral, making it a practical upgrade for surgical teams seeking to improve long-term outcomes.
Given the evidence, surgeons should consider integrating the small-bites technique into their closure protocols for midline laparotomies.
Not only does this approach reduce the risk of hernia, but it also aligns with evolving best practices to minimise postoperative complications.
The authors concluded: ‘The small-bites technique reduced the long-term risk and width of incisional hernias after elective midline laparotomy. Given its simplicity, cost neutrality, and broad applicability, it should be regarded as standard practice.’
Further research is needed to validate the findings across diverse settings and patient populations, they added.
