Abstract：
OBJECTIVE: Incisional ventral hernias (IVH) are common after laparotomies, with up to 20% incidence in 12 months, increasing up to 60% at 3-5 years. Although Small Bites (SB) is the standard technique for fascial closure in laparotomies, its adoption in the United States is limited, and Large Bites (LB) is still commonly performed. We aim to assess the effectiveness of SB regarding IVH.
METHODS: We searched for RCTs and observational studies on Cochrane, EMBASE, and PubMed from inception to May 2023. We selected patients ≥ 18 years old, undergoing midline laparotomies, comparing SB and LB for IVH, surgical site infections (SSI), fascial dehiscence, hospital stay, and closure duration. We used RevMan 5.4. and RStudio for statistics. Heterogeneity was assessed with I2 statistics, and random effect was used if I2 > 25%.
RESULTS: 1687 studies were screened, 45 reviewed, and 6 studies selected, including 3 RCTs and 3351 patients (49% received SB and 51% LB). SB showed fewer IVH (RR 0.54; 95% CI 0.39-0.74; P < 0.001) and SSI (RR 0.68; 95% CI 0.53-0.86; P = 0.002), shorter hospital stay (MD -1.36 days; 95% CI -2.35, -0.38; P = 0.007), and longer closure duration (MD 4.78 min; 95% CI 3.21-6.35; P < 0.001). No differences were seen regarding fascial dehiscence.
CONCLUSIONS: SB technique has lower incidence of IVH at 1-year follow-up, less SSI, shorter hospital stay, and longer fascial closure duration when compared to the LB. SB should be the technique of choice during midline laparotomies.
METHODS: We searched for RCTs and observational studies on Cochrane, EMBASE, and PubMed from inception to May 2023. We selected patients ≥ 18 years old, undergoing midline laparotomies, comparing SB and LB for IVH, surgical site infections (SSI), fascial dehiscence, hospital stay, and closure duration. We used RevMan 5.4. and RStudio for statistics. Heterogeneity was assessed with I2 statistics, and random effect was used if I2 > 25%.
RESULTS: 1687 studies were screened, 45 reviewed, and 6 studies selected, including 3 RCTs and 3351 patients (49% received SB and 51% LB). SB showed fewer IVH (RR 0.54; 95% CI 0.39-0.74; P < 0.001) and SSI (RR 0.68; 95% CI 0.53-0.86; P = 0.002), shorter hospital stay (MD -1.36 days; 95% CI -2.35, -0.38; P = 0.007), and longer closure duration (MD 4.78 min; 95% CI 3.21-6.35; P < 0.001). No differences were seen regarding fascial dehiscence.
CONCLUSIONS: SB technique has lower incidence of IVH at 1-year follow-up, less SSI, shorter hospital stay, and longer fascial closure duration when compared to the LB. SB should be the technique of choice during midline laparotomies.
摘要：
目的：开腹腹疝（IVH）在开腹手术后很常见，12个月内发病率高达20%，在3-5年内增加到60％。尽管小叮咬（SB）是腹腔镜手术中筋膜闭合的标准技术，它在美国的采用是有限的，大咬伤（LB）仍然是常见的。我们的目标是评估SB关于IVH的有效性。
方法：我们搜索了Cochrane的RCT和观察性研究，EMBASE,和PubMed从成立到2023年5月。我们选择≥18岁的患者，正在进行中线开腹手术,比较IVH的SB和LB，手术部位感染（SSI），筋膜裂开,住院,和关闭持续时间。我们使用了RevMan5.4。和RStudio用于统计。异质性用I2统计量评估，如果I2>25%，则使用随机效应。
结果：筛选了1687项研究，45审查，选择了6项研究，包括3个RCT和3351例患者(49%接受SB和51%LB)。SB显示较少IVH（RR0.54；95%CI0.39-0.74；P<0.001）和SSI（RR0.68；95%CI0.53-0.86；P=0.002），住院时间较短（MD-1.36天；95%CI-2.35，-0.38；P=0.007），和更长的闭合时间（MD4.78分钟；95%CI3.21-6.35；P<0.001）。关于筋膜裂开没有发现差异。
结论：SB技术在1年随访时IVH的发生率较低，更少的SSI，住院时间缩短,与LB相比，筋膜闭合时间更长。SB应该是中线开腹手术的首选技术。
方法：我们搜索了Cochrane的RCT和观察性研究，EMBASE,和PubMed从成立到2023年5月。我们选择≥18岁的患者，正在进行中线开腹手术,比较IVH的SB和LB，手术部位感染（SSI），筋膜裂开,住院,和关闭持续时间。我们使用了RevMan5.4。和RStudio用于统计。异质性用I2统计量评估，如果I2>25%，则使用随机效应。
结果：筛选了1687项研究，45审查，选择了6项研究，包括3个RCT和3351例患者(49%接受SB和51%LB)。SB显示较少IVH（RR0.54；95%CI0.39-0.74；P<0.001）和SSI（RR0.68；95%CI0.53-0.86；P=0.002），住院时间较短（MD-1.36天；95%CI-2.35，-0.38；P=0.007），和更长的闭合时间（MD4.78分钟；95%CI3.21-6.35；P<0.001）。关于筋膜裂开没有发现差异。
结论：SB技术在1年随访时IVH的发生率较低，更少的SSI，住院时间缩短,与LB相比，筋膜闭合时间更长。SB应该是中线开腹手术的首选技术。
