In a multicenter randomized clinical trial of 559 patients undergoing elective midline laparotomy, small-bites fascial closure (5 mm spacing) vs large-bites closure (10 mm spacing) was associated with a significantly lower 13-year cumulative incidence of incisional hernia (34% vs 49%; hazard ratio, 0.61) and reduced hernia size. These findings support small-bites closure as a durable, cost-neutral technique that improves long-term surgical outcomes and should be considered standard practice.

Source: JAMA Surgery Original Investigation, Invited Commentary