Results of the small bites midline abdominal incision closure after cancer surgery

Aims: The small bite abdominal closure technique has recently been described and popularized, but it still needs to be investigated in oncologic abdominal surgery. This study evaluates the effect of small-bite fascial closure (SBFC) versus standard large-bite fascial closures in surgical oncology patients on incisional hernia rates and local complications. Methods: This retrospective study compares the outcomes of surgeries performed by the same surgical oncologist before and after adopting the small-bite technique. Patients who underwent midline laparotomy for abdominal malignancy and had at least 6 months of postoperative follow-up were included in the study. Before adopting the SBFC technique, the cohort's fascia closure was performed with loop polydioxanone sutures. In contrast, after starting the SBFC, performed closing with 2-0 polydioxanone sutures and fascial bites spaced 5-8 mm. Results: The total hernia rate of the included 85 patients was 16.5% (14/85). Patient characteristics were similar in both cohorts. The SBFC severally reduced hernia rates in the mean follow-up of 11.9 ± 5.6 months from 21.8% to 6.8%, but not statistically significant, p=0.124. According to logistic regression modeling, SBFC (AOR=0.085, 95.0% CI 0.008–0.932, p=0044) was independently associated with a lower probability of hernia formation in multivariant analysis. Other factors related to increased hernia rates were smoking (OR=8.850, 95% CI 2.518–31.110, p<0.001), sarcopenia (OR=8.850, 95% CI 2.518–31.110, p<0.001), diabetes mellitus (OR=3.827, 95% CI 1.045–14.010, p=0.043) and stage 4 cancer disease (OR=12.593, 95% CI 2.565–61.829, p<0.002) in univariate analysis. Surgical site infection, organ or space infection, and complications (Clavien-Dindo) ?3 were lower in the SBFC group, but the difference was not statistically significant (all p>0.005). The early eventration rate was similar. Length of hospital stay was also significantly lower in the SBFC group (p=0.013). Conclusion: The SBFC technique reduces the risk of incisional hernia development in cancer patients undergoing midline laparotomy.