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Randomised controlled (RCT) as well as non-randomised controlled trials (n-RCT) comparing the short (SB) versus large bite (LB) technique for abdominal wall closure after midline laparotomy were eligible for inclusion. Quality assessment was performed for RCTs (ROB) &amp; n-RCTs (ROBINS-1, MINORS). The incidence of IH, SSI, LAD as well as the length of hospital stay (LOS) and time to close the linea alba (aponeurotic layer of the abdominal wall) were analysed as outcome parameters. Odds ratio with 95% confidence intervals were chosen to determine statistical significance. Heterogeneity was explored using the I\n                      <jats:sup>2<\/jats:sup>\n                      -statistics and funnel plots evaluated a possible publication bias.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      This SR\/MA comprised in total 5886 patients (large bite group 3339 vs. 2547 short bite group) enrolled in 7 RCTs and 5 n-RCTs. The SB-technique was associated with a significant lower IH, SSI, FD rate and a shorter LOS compared to the LB-technique (IH: Odds Ratio OR\u2009=\u20090.47 (95% CI 0.38\u20130.58;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.00001; I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200911%)); SSI: OR\u2009=\u20090.53 (95% CI 0.42\u20130.67;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.00001; I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%); FD: OR\u2009=\u20090.60 (95% CI 0.38\u20130.93;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02; I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%); LOS: Mean difference in days MD = -1.04 (95% CI -1.70, -0.37;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002; I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200913%), respectively). Furthermore, pooled effect estimates derived from RCTs were comparable to n-RCTs. No statistical relevant publication bias was detected, and the confidence of resulting evidence was high according to the validated GRADE tool.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This systematic review and meta-analysis demonstrate consistent reductions in incisional hernia and surgical site infection with the small bites technique for midline laparotomy closure. The direction of effect is stable across randomized and comparative studies and supported by available long-term data. The clinical relevance and consistency of these findings support preferential use of the small bites technique in routine practice. The present evidence provides a robust basis for consideration in future updates of EHS abdominal wall closure guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration<\/jats:title>\n                    <jats:p>PROSPERO, registration number: CRD420251033244, registration date: 16th April 2025.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10029-026-03700-z","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T03:54:51Z","timestamp":1779162891000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of the SUture BIte TEchnique on clinical outcomes after midline laparotomy closure: SUBITE\u2014a systematic review and meta-analysis"],"prefix":"10.1007","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8844-4922","authenticated-orcid":false,"given":"Markus","family":"Golling","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petra","family":"Baumann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Kuger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0066-7716","authenticated-orcid":false,"given":"Ren\u00e9 H.","family":"Fortelny","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"3700_CR1","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/1471-2482-9-8","volume":"9","author":"NN Rahbari","year":"2009","unstructured":"Rahbari NN, Knebel P, Diener MK, Seidlmayer C, Ridwelski K, St\u00f6ltzing H, Seiler CM (2009) Current practice of abdominal wall closure in elective surgery - Is there any consensus? 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This is irrespective of his research validity and the coauthor ship of this Systematic Review & Meta analysis. Moreover, he has received contributions for presentations by other medical companies such as Baxter, Becton Dickinson, Falk, Gore, Johnson & Johnson and Medtronic. He is not financially involved in any of these companies.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"RF reports having received research funding from B. Braun and Becton Dickinson for involvement in clinical studies within the last 36 months. RF further reports having received honoraria for scientific presentations and educational activities from Fasciotens and Medtronic within the last 36 months. These relationships are unrelated to the content, design, analysis, interpretation, or reporting of the present manuscript. RF declares no consultancy roles, no advisory board memberships, no equity interests, no stock ownership, and no other financial or non-financial conflicts of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"221"}}