Van Den Berg R, Van Egmond S, Smits F, Baart SJ, Aufenacker TJ, Cense HA et al.
JAMA Surg 2026; 161: 566-573.
Some 559 patients were randomized, and at median follow-up of 13 years, cumulative incidence of incisional hernia was lower in the small-bites group (hazard ratio 0.61, 95 per cent confidence interval 0.43 to 0.86). Hernias that occurred after small-bites closure were significantly smaller when compared to those after large-bites closure (mean 25 mm versus 43 mm, P=0.02).
Comment: With compelling long-term evidence supporting small-bites fascial closure, the challenge is translating these findings into routine surgical practice.
Comment by Jeongyoon (Jenny) Moon, MD
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