Efficacy of Small-Bite Closure for Hernia in CRC Surgery

An incisional hernia frequently develops after open surgery for colorectal cancer (CRC), leading to considerable health risks in the short and long term.

Cumhur Ozcan and the team aimed to evaluate the efficacy of small-bite abdominal closure techniques in reducing the occurrence of incisional hernia in patients undergoing open CRC surgery.

They conducted an RCT between June 2019 and June 2022, in which 173 patients undergoing open CRC surgery participated. The patients were divided into 2 groups randomly: 87 patients had small-bite fascial closure and 86 patients had conventional bites. The primary outcome was the rate of incisional hernia while incidence of surgical-site infection was also evaluated.

The results indicated that after 1 year, incisional hernia rates were 7% for the small-bite group and 27% for the conventional-bite group (P<0.001). By the second year, rates increased to 9% and 31%, respectively (P<0.001). Surgical-site infections occurred in 18% of the small-bite group and 31% of the conventional-bite group (P=0.03). The small-bite group had higher suture/wound length ratios (5.18 [0.84] vs. 3.67 [0.57]; P<0.001) and longer fascial closure times (14.1 [4.64] vs. 12.9 [2.39] minutes, P=0.03).

The study concluded that small-bite closure with 5-mm tissue bites placed 5 mm apart significantly reduced the incidence of incisional hernia and surgical-site infection following open CRC surgery.

The study was funded by the Sağlık Bakanlığı (SGK).

Source: https://pubmed.ncbi.nlm.nih.gov/39107062/

Ozcan C, Colak T, Turkmenoglu O, et al. (2024). “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. doi: 10.1093/bjs/znae189. PMID: 39107062.