A multicenter trial shows that small-bites fascial closure significantly lowers the incidence of incisional hernias compared to large bites after midline laparotomy.

• Cumulative hernia incidence at 13 years: 34% (small bites) vs. 49% (large bites), hazard ratio 0.61.
• Hernias over 20 mm: 17% in small-bites group vs. 34% in large-bites group, hazard ratio 0.36.

Using the small-bites technique can lead to better long-term outcomes for patients.

• Smaller mean hernia size in small-bites group: 25 mm vs. 43 mm, p = 0.02.