Small-bite closure roughly halves incisional hernia after midline laparotomy

The edition in brief

A meta-analysis of ten randomised trials (2,617 patients) found small-bite fascial closure of midline laparotomy — 5 mm bites at 5 mm spacing — reduced incisional hernia compared with large-bite closure (pooled RR 0.48 at more than 12 months; RR 0.56 beyond 24 months), with fewer surgical-site infections and about five minutes more closing time. A US cohort of 379,858 adults with obesity and type 2 diabetes found metabolic bariatric surgery was associated with lower five-year nephropathy, retinopathy, major cardiovascular events and death than starting obesity medications, with 25% versus 6% weight loss at one year; it is observational and the comparison is with real-world drug use, where persistence is often poor. Five-year follow-up of the Korean COLRAR trial (295 patients) found robotic and laparoscopic total mesorectal excision gave similar overall and relapse-free survival; a post-hoc signal of better local control after chemoradiotherapy needs confirmation. A Brazilian non-inferiority trial in 201 children with perforated appendicitis found once-daily metronidazole 30 mg/kg, with gentamicin, was non-inferior to thrice-daily dosing for surgical-site infection.