Stefan Morarasu, Sorinel Lunca, Luke O'Brien, Paul Lynch, Ana Maria Musina, Cristian Ene Roata, Raluca Zaharia, Wee Liam Ong, Gabriel-Mihail Dimofte, Cillian Clancy
{"title":"中线剖腹术小咬合与大咬合：一项系统综述和荟萃分析","authors":"Stefan Morarasu, Sorinel Lunca, Luke O'Brien, Paul Lynch, Ana Maria Musina, Cristian Ene Roata, Raluca Zaharia, Wee Liam Ong, Gabriel-Mihail Dimofte, Cillian Clancy","doi":"10.1111/codi.70073","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Aim</h3>\n \n <p>Surgical site infection (SSI) and incisional hernia (IH) are common complications following midline laparotomy. The small-bites technique for closing a midline laparotomy has been suggested to improve SSI and IH rates compared with the classic mass closure. The aim of this work was to perform a systematic review, meta-analysis and fragility assessment of existing evidence comparing small-bites and conventional closure.</p>\n </section>\n \n <section>\n \n <h3> Method</h3>\n \n <p>The study was registered with PROSPERO. A systematic search of PubMed and EMBASE databases was performed for all comparative studies examining small-bites versus conventional closure for midline laparotomy. The fragility index for randomized controlled trials (RCTs) was assessed and the number of outcomes required to render results insignificant using the Fisher exact test was calculated.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Seven studies were included, with a total of 3807 patients. Small bites was performed in 1768 and large bites in 2039. Follow-up ranged from 12 to 52 months. On meta-analysis of all studies, small bites is associated with a lower risk of IH (<i>p</i> < 0.00001), SSI (<i>p</i> = 0.0002) and wound dehiscence (<i>p</i> = 0.02). On meta-analysis of RCTs there is a lower risk of IH (<i>p</i> = 0.01) but no difference in SSI (<i>p</i> = 0.06) or wound dehiscence (<i>p</i> = 0.73). Fragility is evident among RCTs reporting differences in IH rates.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>There is evidence to suggest that small-bites closure provides a decreased likelihood of IH over varying follow-up in RCTs but significant fragility exists among studies.</p>\n </section>\n </div>","PeriodicalId":10512,"journal":{"name":"Colorectal Disease","volume":"27 3","pages":""},"PeriodicalIF":2.7000,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/codi.70073","citationCount":"0","resultStr":"{\"title\":\"Small-bites versus large-bites closure of midline laparotomies: A systematic review and meta-analysis\",\"authors\":\"Stefan Morarasu, Sorinel Lunca, Luke O'Brien, Paul Lynch, Ana Maria Musina, Cristian Ene Roata, Raluca Zaharia, Wee Liam Ong, Gabriel-Mihail Dimofte, Cillian Clancy\",\"doi\":\"10.1111/codi.70073\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Aim</h3>\\n \\n <p>Surgical site infection (SSI) and incisional hernia (IH) are common complications following midline laparotomy. The small-bites technique for closing a midline laparotomy has been suggested to improve SSI and IH rates compared with the classic mass closure. The aim of this work was to perform a systematic review, meta-analysis and fragility assessment of existing evidence comparing small-bites and conventional closure.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Method</h3>\\n \\n <p>The study was registered with PROSPERO. A systematic search of PubMed and EMBASE databases was performed for all comparative studies examining small-bites versus conventional closure for midline laparotomy. The fragility index for randomized controlled trials (RCTs) was assessed and the number of outcomes required to render results insignificant using the Fisher exact test was calculated.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Seven studies were included, with a total of 3807 patients. Small bites was performed in 1768 and large bites in 2039. Follow-up ranged from 12 to 52 months. On meta-analysis of all studies, small bites is associated with a lower risk of IH (<i>p</i> < 0.00001), SSI (<i>p</i> = 0.0002) and wound dehiscence (<i>p</i> = 0.02). On meta-analysis of RCTs there is a lower risk of IH (<i>p</i> = 0.01) but no difference in SSI (<i>p</i> = 0.06) or wound dehiscence (<i>p</i> = 0.73). 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Small-bites versus large-bites closure of midline laparotomies: A systematic review and meta-analysis
Aim
Surgical site infection (SSI) and incisional hernia (IH) are common complications following midline laparotomy. The small-bites technique for closing a midline laparotomy has been suggested to improve SSI and IH rates compared with the classic mass closure. The aim of this work was to perform a systematic review, meta-analysis and fragility assessment of existing evidence comparing small-bites and conventional closure.
Method
The study was registered with PROSPERO. A systematic search of PubMed and EMBASE databases was performed for all comparative studies examining small-bites versus conventional closure for midline laparotomy. The fragility index for randomized controlled trials (RCTs) was assessed and the number of outcomes required to render results insignificant using the Fisher exact test was calculated.
Results
Seven studies were included, with a total of 3807 patients. Small bites was performed in 1768 and large bites in 2039. Follow-up ranged from 12 to 52 months. On meta-analysis of all studies, small bites is associated with a lower risk of IH (p < 0.00001), SSI (p = 0.0002) and wound dehiscence (p = 0.02). On meta-analysis of RCTs there is a lower risk of IH (p = 0.01) but no difference in SSI (p = 0.06) or wound dehiscence (p = 0.73). Fragility is evident among RCTs reporting differences in IH rates.
Conclusion
There is evidence to suggest that small-bites closure provides a decreased likelihood of IH over varying follow-up in RCTs but significant fragility exists among studies.
期刊介绍：
Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate.
Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases.
Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies.
Note that the journal does not usually accept paediatric surgical papers.
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