A randomized controlled clinical trial comparing the outcomes of circumferential subcuticular wound approximation (CSWA) with conventional wound closure after stoma reversal

Abstract

With regard to wound infection rates, the CSWA method was better than the conventional method, although this was found to be borderline significant. With regard to patient satisfaction, the CSWA method proved to be superior to the conventional method, and this was found to be statistically significant. In addition, the technique is applicable to all forms of stoma regardless of the bowel segment involved, trephine size, and indication for diversion.

Considerations in Stoma Reversal

“…Furthermore, outcomes were not significantly different between ileostomy and colostomy patients. 35 A smaller nonrandomized trial of 48 patients comparing purse-string closure to primary closure also found decreased surgical site infection rates (0 vs. 21.4%; p < 0.021) and more satisfaction with scar (p ¼ 0.043) when compared with the primary closure technique. This study, however, revealed longer time to complete healing with the purse-string technique (32 vs. 19 days; p < 0.0001) when compared with primary closure.…”

“…Surgical site infections are frequent complications following stoma reversal and are reported occur in 2 to 41% of patients. [35][36][37] Wound infection after stoma closure can have significant ramifications such as wound dehiscence, incisional hernia, longer hospital stays, and increased hospital costs. A 2011 analysis estimated a per-patient hospital cost of an episode of surgical site infection was US$2,600 with an additional US$6,200 for postdischarge care.…”

“…36 Purse-string closures are loosely packed with iodine-soaked gauze, which was removed at 48 hours, and then covered with dry gauze dressing. 35 Nonabsorbable sutures are removed 8 to 10 days postoperatively. 35 Primary closure can be performed with interrupted 2-0 nonabsorbable monofilament or 3-0 absorbable monofilament suture, or a stapled closure.…”

“…35 Nonabsorbable sutures are removed 8 to 10 days postoperatively. 35 Primary closure can be performed with interrupted 2-0 nonabsorbable monofilament or 3-0 absorbable monofilament suture, or a stapled closure. 41 A recent meta-analysis including four randomized controlled trials and 319 patients compared purse-string closure (n ¼ 162) to primary closure (n ¼ 157).…”

“…42 Data have repeatedly suggested that purse-string closure of the stoma closure site results in lower surgical site infections and improved patient satisfaction when compared with primary closure. 35,36,[41][42][43][44][45] Hartmann's Reversal…”