{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T19:11:26Z","timestamp":1792609886401,"version":"4.5.0"},"reference-count":31,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T00:00:00Z","timestamp":1742774400000},"content-version":"vor","delay-in-days":23,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>Surgical site infection (<jats:styled-content style=\"fixed-case\">SSI<\/jats:styled-content>) and incisional hernia (<jats:styled-content style=\"fixed-case\">IH<\/jats:styled-content>) are common complications following midline laparotomy. The small\u2010bites technique for closing a midline laparotomy has been suggested to improve <jats:styled-content style=\"fixed-case\">SSI<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">IH<\/jats:styled-content> rates compared with the classic mass closure. The aim of this work was to perform a systematic review, meta\u2010analysis and fragility assessment of existing evidence comparing small\u2010bites and conventional closure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>The study was registered with PROSPERO. A systematic search of PubMed and EMBASE databases was performed for all comparative studies examining small\u2010bites 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seven studies were included, with a total of 3807 patients. Small bites was performed in 1768 and large bites in 2039. Follow\u2010up ranged from 12 to 52\u2009months. On meta\u2010analysis of all studies, small bites is associated with a lower risk of IH (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.00001), SSI (<jats:italic>p<\/jats:italic>\u2009=\u20090.0002) and wound dehiscence (<jats:italic>p<\/jats:italic>\u2009=\u20090.02). On meta\u2010analysis of RCTs there is a lower risk of IH (<jats:italic>p<\/jats:italic>\u2009=\u20090.01) but no difference in SSI (<jats:italic>p<\/jats:italic>\u2009=\u20090.06) or wound dehiscence (<jats:italic>p<\/jats:italic>\u2009=\u20090.73). Fragility is evident among RCTs reporting differences in IH rates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>There is evidence to suggest that small\u2010bites closure provides a decreased likelihood of IH over varying follow\u2010up in RCTs but significant fragility exists among studies.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.70073","type":"journal-article","created":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T17:47:17Z","timestamp":1743011237000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Small\u2010bites versus large\u2010bites closure of midline laparotomies: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7767-0975","authenticated-orcid":false,"given":"Stefan","family":"Morarasu","sequence":"first","affiliation":[{"name":"2nd Department of Surgical Oncology Regional Institute of 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