1027 Small Bite vs Big Bite Closure Technique in Elective Oesophagectomy Patients
G Williams, A Devashetty, E McLaughlin- Surgery
Abstract
Aim
After primary closure of a midline laparotomy wounds the estimated incisional hernia incidence can be as high as 25%. For many years large bite closure has been the standard in mainstream surgical training. Evidence has emerged to suggest small bite closure may be superior. We looked to examine the incidence of incisional hernias for elective oesophagectomies in one centre where both small bite and large bite techniques are performed.
Method
A retrospective analysis of 117 patients was performed. Follow up was for a maximum of five years and involved a combination of radiological and clinical reviews. Primary outcomes were defined as incisional hernia rates & wound infections. Patient risk factors were recorded including age, co-morbidities such as cardiovascular or renal disease, diabetes, smoking, weight, steroid use and post-op complications.
Results
74 patients had big bite closures and 38 had small bite closures. Overall there were 6 incisional hernias, 3 in each group (7.8% vs 4%, p-value 0.2). There were higher rates of wound infection in the small bite groups but again this failed to reach significance (7.9% vs 2.7% p-value 0.11).
Conclusions
Overall both outcomes are lower than the national averages which may explain the difficulty reaching significance. However, the results do suggest there may be other factors involved contributing to outcomes between small bite and big bite closure including operator familiarity.