Continuous fascial closure using absorbable barbed sutures lowers the risk of incisional hernia after minimally invasive colorectal surgery: a consecutive single-surgeon retrospective cohort study.

[BACKGROUND] Incisional hernia (IH) at extraction sites remains a common late complication of minimally invasive colorectal surgery. Closure technique is a potentially modifiable factor; however, evidence comparing continuous and interrupted fascial closure in this setting is limited.

[METHODS] We conducted a retrospective single-center cohort study involving 397 patients who underwent laparoscopic or robotic colorectal cancer resection by a single surgeon between April 2019 and May 2025. Interrupted fascial closure was routinely performed until March 2022, after which continuous closure was exclusively performed. Primary outcome was 1-year incidence of IH, which was assessed using standardized abdominal computed tomography. Secondary outcomes included perioperative outcomes and postoperative complications.

[RESULTS] Baseline demographics and tumor characteristics were comparable between 213 and 184 patients in interrupted and continuous closure groups, respectively. Robot-assisted procedures were more common in the continuous group (37.0% vs. 13.6%, P  < 0.001), whereas other perioperative factors were similar in both groups. At 1 year, the overall incidence of IH was 14.9%. Continuous closure was associated with a significantly lower IH rate than interrupted closure (10.9% vs. 18.3%, P = 0.047). Multivariate logistic regression identified body mass index of ≥  25 kg/m (odds ratio [OR], 2.29; 95% confidence interval [CI] 1.27-4.16, P = 0.006) and interrupted closure (OR, 1.89; 95% CI 1.05-3.40, P = 0.035) as independent predictors of IH. Rates of surgical site infection and other early complications did not differ significantly between the groups.

[CONCLUSION] Continuous fascial closure using absorbable barbed sutures was associated with a significantly reduced incidence of IH, without increasing short-term morbidity. These findings suggest that closure technique may represent a modifiable determinant of IH risk and support continuous closure as a potentially preferable approach. However, prospective multicenter randomized controlled trials are warranted to validate these results and confirm their generalizability.