Small-Bite Versus Large-Bite Closure for the Prevention of Incisional Hernia: A Meta-Analysis

Incisional hernia remains a common and clinically significant complication following midline laparotomy, contributing to patient morbidity, impaired quality of life, and increased healthcare costs. The fascial closure technique has been recognized as a potentially modifiable factor influencing hernia development. In recent years, the small-bite (short stitch) technique has been proposed as superior to the traditional large-bite (long stitch) method. This meta-analysis aimed to systematically evaluate and compare the effectiveness of small-bite versus large-bite fascial closure in preventing incisional hernia and related wound complications. A comprehensive literature search of PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, ProQuest, and Google Scholar was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify comparative studies published from inception to December 2025. Randomized controlled trials (RCTs) and prospective comparative studies involving adult patients undergoing midline laparotomy were included. The primary outcome was incisional hernia, while secondary outcomes included surgical site infection (SSI) and wound dehiscence. Data were pooled using a DerSimonian-Laird random-effects model, and results were expressed as odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the I² statistic. Five studies comprising diverse elective and emergency surgical populations were included in the quantitative synthesis. Small-bite closure was associated with a significantly reduced risk of incisional hernia compared with large-bite closure (pooled OR: 0.49, 95% CI: 0.33-0.73; p = 0.0004), with low to moderate heterogeneity (I² = 37%). Additionally, small-bite closure significantly decreased the risk of surgical site infection (pooled OR: 0.45, 95% CI: 0.31-0.66; p < 0.0001; I² = 18%) and wound dehiscence (pooled OR: 0.42, 95% CI: 0.26-0.69; p = 0.0006; I² = 41%). Across all outcomes, the direction of effect consistently favored the small-bite technique. This meta-analysis demonstrates that small-bite fascial closure significantly reduces the risk of incisional hernia, surgical site infection, and wound dehiscence following midline laparotomy. These findings support the routine adoption of the small-bite technique as a simple, cost-effective strategy to improve postoperative outcomes.