SP6.10 - The Inevitable Way Ahead: “Small Bites” Closure For Extraction Sites In Colorectal Resections

Abstract Background “Small bites" technique is widely recognised for its benefits in reducing incisional hernias after laparotomy. In 2018, our institution introduced a standardised closure technique using 2-0 PDS sutures in a small bites fashion for laparotomies in colorectal surgery, in contrast to the previously favoured 'loop' PDS mass closure. Training on this technique was provided to surgical staff, although its adoption was not mandatory. This study aimed to review our local rate of incisional hernia at extraction sites following small bites vs mass closure. Method Our retrospective study included all adult patients who underwent laparoscopic or robotic colorectal resections involving an extraction site between 2018 and 2022. The closure technique used and incidence of hernia was evaluated; all patients had a minimum of 2 years clinical or radiological follow up. Results Of the 403 resections over 5 years, 249 met the inclusion criteria (47% female; median age 69 years, range 31-89). Robotic procedures accounted for 21.7% (n=54), and 54.6% (n=136) were for T3 cancers, with 69.1% (n=172) classified as N0. Most cases, 77.5% (n=193), featured midline extraction sites, while 22.5% were off-midline (i.e. transverse). Mass closure was employed in 54.6% of cases (n=136), with 19.9% (n=27) developing confirmed extraction site hernias. Small bites closure was utilised in 45.4% of cases (n=113), with 5.3% (n=6) experiencing confirmed extraction site hernias (p<0.05). Conclusion Our data, the first of its kind, highlights a potential significant difference in extraction site hernia rates between mass closure (19.9%) and small bites closure (5.3% (p<0.05)). Moving forward, if done correctly, small bites closure should be considered the gold standard for extraction sites.