Small bites technique for midline laparotomy closure: From theory to practice: Still a long way to go

Rodríguez, José Antonio Pereira; Amador-Gil, Sara; Bravo-Salvá, Alejandro; Montcusí-Ventura, B.; Sancho-Insenser, Joan; Pera-Román, Miguel; López-Cano, Manuel

doi:10.1016/j.surg.2020.12.007

Cited by 18 publications

(18 citation statements)

References 22 publications

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“…The goal of the review was to answer the question posed at the start of the article; whether small bites can reduce the incidence of incisional hernia following midline laparotomy when compared to the conventional mass closure technique, with the latter being the regular practice of most of today's surgeons for several years if not for their entire career which makes the transition even more difficult if another technique is proven to be superior [ 11 , 12 ]. Nevertheless, we think by generating high-quality evidence of the small bite/small stitch technique in the form of best evidence topic, might help in adoption of this technique by more units.…”

Section: Discussionmentioning

confidence: 99%

Does small bite closure reduce the incidence of incisional hernia compared to standard mass closure for midline laparotomy?

Elsamani¹,

Rahim²,

Hamid³

2022

Annals of Medicine &Amp; Surgery

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Section: Discussionmentioning

confidence: 99%

Does small bite closure reduce the incidence of incisional hernia compared to standard mass closure for midline laparotomy?

Elsamani¹,

Rahim²,

Hamid³

2022

Annals of Medicine &Amp; Surgery

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“…Thus far, studies about EML closure have shown better results when using the SB technique, but they were carried out in non-selected patients [ 3 , 4 , 11 ]. In our study, isolated use of SB, although in a small number of patients, presented a similar frequency of IH than in those treated with NSB, indicating that this group of patients could not benefit as much from this technique as low-risk patients.…”

Section: Discussionmentioning

confidence: 99%

“…Melsungen, Germany), and using the SB technique and introducing the measurement and systematic documentation of the SL/WL ratio. For that purpose, training actions, which have been previously described, [ 11 ] were carried out, and all surgical specialties that perform EML were involved (General and Digestive Surgery, Gynecology, Urology, Vascular). In addition, the use of PM in high-risk patients was emphasised, following updated guidelines [ 2 ].…”

Section: Methodsmentioning

confidence: 99%

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Implementing a protocol to prevent incisional hernia in high-risk patients: a mesh is a powerful tool

Rodríguez

Amador-Gil

Bravo-Salvá

et al. 2021

Hernia

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Purpose The small bites (SB) technique for closure of elective midline laparotomies (EMLs) and a prophylactic mesh (PM) in high-risk patients are suggested by the guidelines to prevent incisional hernias (IHs) and fascial dehiscence (FD). Our aim was to implement a protocol combining both the techniques and to analyze its outcomes. Methods Prospective data of all EMLs were collected for 2 years. Results were analyzed at 1 month and during follow-up. The incidence of HI and FD was compared by groups (M = Mesh vs. S = suture) and by subgroups depending on using SB. Results A lower number of FD appeared in the M group (OR 0.0692; 95% CI 0.008–0.56; P = 0.01) in 197 operations. After a mean follow-up of 29.23 months (N = 163; min. 6 months), with a lower frequency of IH in M group (OR 0.769; 95% CI 0.65–0.91; P < 0.0001). (33) The observed differences persisted after a propensity matching score: FD (OR 0.355; 95% CI 0.255–0.494; P < 0.0001) and IH (OR 0.394; 95% CI 0.24–0.61; P < 0.0001). On comparing suturing techniques by subgroups, both mesh subgroups had better outcomes. PM was the main factor related to the reduction of IH (HR 11.794; 95% CI 4.29–32.39; P < 0.0001). Conclusion Following the protocol using PM and SB showed a lower rate of FD and HI. A PM is safe and effective for the prevention of both HI and FD after MLE, regardless of the closure technique used.

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“…In the years following the initial guidelines, a significant number of studies further defined the small bites technique and provided a clear, detailed and easy to follow procedure ( 21 ). In contrast to these findings and even though recent surveys showed that the small bites technique is reproducible, has no risks and provides low incidence of incisional hernia, a wide dissemination and “real world” implementation is still not optimal in the surgical community ( 22 , 23 ). In the published literature, no specific explanations for this dogged acceptance of an empiriously validated technique can be found.…”

Section: Introductionmentioning

confidence: 93%

Don't fear the (small) bite: A narrative review of the rationale and misconceptions surrounding closure of abdominal wall incisions

Theodorou

Banysch²,

Gök³

et al. 2022

Front. Surg.

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BackgroundThe most common complications related to the closure of abdominal wall incisions are surgical site infections, wound dehiscence and the development of an incisional hernia. Several factors relating to the surgical technique and the materials used have been identified and analysed over the years, as mirrored in the current recommendations of the European Hernia Society, but some misconceptions still remain that hinder wide implementation.MethodA literature search was performed in the PubMed and GoogleScholar databases on 15 July 2021 and additionally on 30 March 2022 to include recent updates. The goal was to describe the scientific background behind the optimal strategies for reducing incisional hernia risk after closure of abdominal wall incisions in a narrative style reviewResultsAn aponeurosis alone, small bites/small steps continuous suture technique should be used, using a slowly resorbable USP 2/0 or alternatively USP 0 suture loaded in a small ½ circle needle. The fascial edges should be properly visualised and tension should be moderate.ConclusionDespite the reproducibility, low risk and effectiveness in reducing wound complications following abdominal wall incisions, utilisation of the recommendation of the guidelines of the European Hernia Society remain relatively limited. More work is needed to clear misconceptions and disseminate the established knowledge and technique especially to younger surgeons

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Small bites technique for midline laparotomy closure: From theory to practice: Still a long way to go

Cited by 18 publications

References 22 publications

Does small bite closure reduce the incidence of incisional hernia compared to standard mass closure for midline laparotomy?

Does small bite closure reduce the incidence of incisional hernia compared to standard mass closure for midline laparotomy?

Implementing a protocol to prevent incisional hernia in high-risk patients: a mesh is a powerful tool

Don't fear the (small) bite: A narrative review of the rationale and misconceptions surrounding closure of abdominal wall incisions

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