# Effectiveness of Small Bites Closure in Reducing Incisional Hernia at Specimen Extraction Sites Following Minimally Invasive Colorectal Cancer Surgery

## TL;DR

This study shows that using the small bites closure technique during colorectal cancer surgery reduces the risk of incisional hernias compared to mass closure.

## Contribution

The study provides evidence that small bites closure is more effective in preventing incisional hernias than mass closure in minimally invasive colorectal surgery.

## Key findings

- Small bites closure had a 5.3% incisional hernia rate versus 19.9% with mass closure.
- Midline extraction sites had a higher hernia incidence (16.8%) than off-midline sites (1.8%).
- Patients with a BMI ≥30 had a 24.2% hernia rate compared to 8.9% for those with a BMI <30.

## Abstract

Introduction and aims: This study compares the incidence of incisional hernia (IH) at extraction sites in minimally invasive colorectal cancer resections using the small bites closure technique versus mass closure.

Methods: We conducted a single-centre retrospective study at our UK hospital, including all adult patients who underwent laparoscopic or robotic colorectal cancer resections between 2018 and 2023. Patients were divided into two groups based on the closure technique: small bites and mass closure. The incidence of IH at the extraction site was confirmed either clinically or radiologically during routine follow-ups. Fisher's exact test was used to compare IH rates between the groups, with significance set at p<0.05.

Results: A total of 246 patients were included in the study, divided into small bites (n=112) and mass closure (n=134) groups, with a median age of 69 years (range 31-89). The overall incidence of IH was 13.4% (n=33). IH rates were significantly lower in the small bites group (5.3%; n=6) compared to the mass closure group (19.9%; n=27) (p=0.006). Midline extraction sites had a higher IH incidence (16.8%) compared to off-midline sites (1.8%) (p=0.003). Additionally, patients with a BMI ≥30 kg/m² had a higher IH incidence (24.2%) compared to those with a BMI <30 kg/m² (8.9%) (p=0.003).

Conclusion: This study suggests that the small bites technique significantly reduces the incidence of IH at extraction sites in minimally invasive colorectal cancer resections compared to mass closure. Patient factors such as body mass index (BMI) and extraction site location are also critical in IH development.