# Reduced Fascial Dehiscence with Combined Small-and-Large Technique Compared to Small-Bite Technique in Emergency Midline Laparotomy: A Retrospective Study

## TL;DR

This study compares two surgical techniques for closing the abdomen after emergency surgery and finds the combined method may reduce the risk of the incision reopening.

## Contribution

The study introduces the combined small-and-large technique as a potential improvement over the small-bite technique for reducing fascial dehiscence.

## Key findings

- The combined small-and-large technique showed a lower rate of fascial dehiscence compared to the small-bite technique.
- Propensity score matching revealed one case of dehiscence in the combined group versus five in the small-bite group.
- The difference in dehiscence rates was not statistically significant.

## Abstract

This study aimed to compare the rates of fascial dehiscence after fascial closure using the combined small-and-large technique versus the small-bite technique following emergency laparotomy.

A retrospective, single-center, observational study was conducted. All patients who underwent emergency midline laparotomy at the University Hospital Frankfurt in from 2022 till 2024 with either small-bite technique were included or combined small-and-large technique, which involves periodic internal reinforcement sutures. Propensity score matching was performed based on preoperative predictors of fascial dehiscence. The rate of fascial dehiscence was compared between the matched groups.

A total of 294 patients were included. The combined small-and-large technique was used for fascial closure in 37 cases (12.6%), while the small-bite technique was used in 257 cases (87.5%). In descriptive statistics, fascial dehiscence was observed in 31 cases (10.5%); two cases (5.4%) in the group with combined small-and-large technique and 29 cases (11.3%) in the group with small-bite technique. After perfoming propensity score matching 29 cases were matched in each group, with one case of fascial dehiscence in the combined small-and-large technique versus 5 cases the small-bite technique group. However, there was no statistically significant difference.

A lower rate of fascial dehiscence may be achieved using the combined small-and-large technique following emergency laparotomy compared to the small-bite technique.

The online version contains supplementary material available at 10.1007/s10029-025-03536-z.