Small bite versus large bite stitching technique for midline laparotomy wound closure: A systematic review and meta-analysis
Mass closure with a continuous suture using large bite stitching technique has been widely accepted for midline laparotomy wound closures. However, emerging evidence suggests the use of small bite technique to reduce rates of incisional ventral hernia, surgical site infection (SSI) and burst abdomen...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-11-01
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| Series: | Asian Journal of Surgery |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S101595842301285X |
| _version_ | 1797637631711903744 |
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| author | Erwin Yii James Onggo Ming Kon Yii |
| author_facet | Erwin Yii James Onggo Ming Kon Yii |
| author_sort | Erwin Yii |
| collection | DOAJ |
| description | Mass closure with a continuous suture using large bite stitching technique has been widely accepted for midline laparotomy wound closures. However, emerging evidence suggests the use of small bite technique to reduce rates of incisional ventral hernia, surgical site infection (SSI) and burst abdomen. This meta-analysis aims to compare small versus large bite stitching techniques to assess complication rates in midline laparotomy wound closures. A comprehensive multi-database search (OVID EBM Reviews, OVID Medline, EMBASE, Scopus) was conducted from database inception to 11th October 2021 according to PRISMA guidelines. We included studies comparing post-operative complication rates of small bite versus large bite stitching techniques for midline laparotomy wound closure. Extracted data was pooled for meta-analysis evaluating rates of incisional ventral hernia, SSI and burst abdomen. We included five randomized controlled trials (RCT) in the meta-analysis and three prospective cohort studies for qualitative analysis. A total of 1977 participants composed of 961 small bite and 1016 large bite technique patients were included from the five RCTs. There was a significant reduction in the rates of incisional ventral hernia and SSI with the small bite stitch technique with odds ratios (OR) of 0.39 (95% CI [0.21–0.71]) and 0.68 (95% CI [0.51–0.91]) respectively, and a trend in favour of reduced incidence of burst abdomen with OR of 0.60 (95% CI [0.15–2.48]). Small bite stitch technique in midline laparotomy wound closure may be superior over conventional mass closure using the large bite stitch technique, with statistically significant lower rates of incisional ventral hernia and SSI. |
| first_indexed | 2024-03-11T12:51:11Z |
| format | Article |
| id | doaj.art-f0c31ba902424cbdabc5fc0a45b7c893 |
| institution | Directory Open Access Journal |
| issn | 1015-9584 |
| language | English |
| last_indexed | 2024-03-11T12:51:11Z |
| publishDate | 2023-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Asian Journal of Surgery |
| spelling | doaj.art-f0c31ba902424cbdabc5fc0a45b7c8932023-11-04T04:18:30ZengElsevierAsian Journal of Surgery1015-95842023-11-01461147194726Small bite versus large bite stitching technique for midline laparotomy wound closure: A systematic review and meta-analysisErwin Yii0James Onggo1Ming Kon Yii2Box Hill Hospital, Department of Surgery, Box Hill, Victoria, Australia; Corresponding author. Box Hill Hospital, 8 Arnold Street, Box Hill, VIC, 3128, Australia.Box Hill Hospital, Department of Surgery, Box Hill, Victoria, AustraliaMonash University, Department of Surgery, School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia; Monash Medical Centre Clayton, Vascular and Transplant Surgery Unit at Monash Health, Clayton, Victoria, AustraliaMass closure with a continuous suture using large bite stitching technique has been widely accepted for midline laparotomy wound closures. However, emerging evidence suggests the use of small bite technique to reduce rates of incisional ventral hernia, surgical site infection (SSI) and burst abdomen. This meta-analysis aims to compare small versus large bite stitching techniques to assess complication rates in midline laparotomy wound closures. A comprehensive multi-database search (OVID EBM Reviews, OVID Medline, EMBASE, Scopus) was conducted from database inception to 11th October 2021 according to PRISMA guidelines. We included studies comparing post-operative complication rates of small bite versus large bite stitching techniques for midline laparotomy wound closure. Extracted data was pooled for meta-analysis evaluating rates of incisional ventral hernia, SSI and burst abdomen. We included five randomized controlled trials (RCT) in the meta-analysis and three prospective cohort studies for qualitative analysis. A total of 1977 participants composed of 961 small bite and 1016 large bite technique patients were included from the five RCTs. There was a significant reduction in the rates of incisional ventral hernia and SSI with the small bite stitch technique with odds ratios (OR) of 0.39 (95% CI [0.21–0.71]) and 0.68 (95% CI [0.51–0.91]) respectively, and a trend in favour of reduced incidence of burst abdomen with OR of 0.60 (95% CI [0.15–2.48]). Small bite stitch technique in midline laparotomy wound closure may be superior over conventional mass closure using the large bite stitch technique, with statistically significant lower rates of incisional ventral hernia and SSI.http://www.sciencedirect.com/science/article/pii/S101595842301285XSmall bitesLarge bitesAbdominal wound closureIncisional/ventral herniaLaparotomy wound closureSurgical site infection |
| spellingShingle | Erwin Yii James Onggo Ming Kon Yii Small bite versus large bite stitching technique for midline laparotomy wound closure: A systematic review and meta-analysis Asian Journal of Surgery Small bites Large bites Abdominal wound closure Incisional/ventral hernia Laparotomy wound closure Surgical site infection |
| title | Small bite versus large bite stitching technique for midline laparotomy wound closure: A systematic review and meta-analysis |
| title_full | Small bite versus large bite stitching technique for midline laparotomy wound closure: A systematic review and meta-analysis |
| title_fullStr | Small bite versus large bite stitching technique for midline laparotomy wound closure: A systematic review and meta-analysis |
| title_full_unstemmed | Small bite versus large bite stitching technique for midline laparotomy wound closure: A systematic review and meta-analysis |
| title_short | Small bite versus large bite stitching technique for midline laparotomy wound closure: A systematic review and meta-analysis |
| title_sort | small bite versus large bite stitching technique for midline laparotomy wound closure a systematic review and meta analysis |
| topic | Small bites Large bites Abdominal wound closure Incisional/ventral hernia Laparotomy wound closure Surgical site infection |
| url | http://www.sciencedirect.com/science/article/pii/S101595842301285X |
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