Small-Bite Closure After Colorectal Surgery
Trial question
What is the effect of small-bite abdominal closure technique in patients undergoing open CRC surgery?
Study design
Single center
Open label
RCT
Population
Characteristics of study participants
46.0% female
54.0% male
N = 173
173 patients (80 female, 93 male).
Inclusion criteria: patients who underwent open CRC surgery.
Key exclusion criteria: age < 18 years; previous incisional hernia; hernia repair before colorectal surgery; previous abdominal surgery within 3 months.
Interventions
N=87 small-bite technique (fascial closure performed with 5-mm tissue bites placed 5 mm apart).
N=86 conventional technique (a running closure technique with larger bites of 1-cm tissue spaced 1 cm apart).
Primary outcome
Incisional hernia at 1 year
7%
26%
26.0 %
19.5 %
13.0 %
6.5 %
0.0 %
Small-bite
technique
Conventional
technique
Significant
decrease ▼
NNT = 5
Significant decrease in incisional hernia at 1 year (7% vs. 26%; RR 0.27, 95% CI 0.11 to 0.43).
Secondary outcomes
Significant decrease in incisional hernia at 2 years (9% vs. 31%; RR 0.29, 95% CI 0.12 to 0.46).
Significant decrease in surgical site infection (18% vs. 31%; RR 0.58, 95% CI 0.04 to 1.12).
No significant difference in duration of hospital stay (7.16 days vs. 7.41 days; AD -0.25 days, 95% CI -1.3 to 0.8).
Conclusion
In patients who underwent open CRC surgery, small-bite technique was superior to conventional technique with respect to incisional hernia at 1 year.
Reference
Cumhur Ozcan, Tahsin Colak, Ozgur Turkmenoglu et al. Impact of small-bite (5 mm) fascial closure on the incidence of incisional hernia following open colorectal cancer surgery: randomized clinical trial. Br J Surg. 2024 Aug 2;111(8):znae189.
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