Comparison of surgical techniques for stoma closure: A retrospective study of purse-string skin closure versus conventional skin closure following ileostomy and colostomy reversal

Wada, Yuma; Miyoshi, Norikatsu; Ohue, Masayuki; Noura, Shingo; Fujino, Shiki; Sugimura, Keijirou; Akita, Hirofumi; Motoori, Masaaki; Gotoh, Kunihito; Takahashi, Hidenori; Kobayashi, Shogo; Ohmori, Takeshi; Fujiwara, Yoshiyuki; Yano, Masahiko

doi:10.3892/mco.2015.505

Cited by 14 publications

(13 citation statements)

References 13 publications

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“…No significant difference between the two groups for the average length of hospital stay was found in our study. This finding was similar to the results of different closure techniques published previously [ 23 , 27 ]. The reasons why lower wound infection rate did not seem to impact the length of hospital stay might be that the wound infection rate was too little to cause an obvious difference in hospital stay between the groups.…”

Section: Discussionsupporting

confidence: 93%

Temporary closure of colostomy with suture before colostomy takedown improves the postoperative outcomes

Lee

Tsai

et al. 2017

Int J Colorectal Dis

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PurposeTemporary loop colostomy is a common surgical procedure used to avoid complications in high-risk distal anastomosis as well as pelvic inflammation. Issues regarding postoperative outcomes of colostomy takedown have been widely discussed in the literature, wound infection especially. Temporary closure of colostomy with suture before takedown was adopted in our study, which provided excellent traction to aid mobilization of stomy and avoided stool spillage to downgrade the wound classification to “clean contamination.” We aimed to determine the effects of the procedure on postoperative outcomes.MethodsThis was a prospective case-control study at a single tertiary medical center. Patients presenting for elective colostomy takedown were included. Allis clamp (n = 50) or silk suture (n = 60) was applied to mobilize the colostomy, and results were compared. Operative time and wound infection rate were measured as primary postoperative outcomes. Univariate and multivariate analyses were used to demonstrate the association between the two groups and outcomes.ResultsIn univariate analyses, significantly shorter operative time (median = 57 min, p = 0.003) and lower postoperative wound infection rate (3%, p = 0.03) were noted in the group receiving silk suture. Multivariate analyses results showed that silk suture was significantly associated with both operative time (B = − 8.5, p = 0.01) and wound infection (odds ratio = 0.18, p = 0.04).ConclusionWith the advantage of enhancing traction and decreasing contamination, the temporary closure of colostomy with suture improved takedown outcomes, including a shorter operative time and lower wound infection rate.

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Section: Discussionsupporting

confidence: 93%

Temporary closure of colostomy with suture before colostomy takedown improves the postoperative outcomes

Lee

Tsai

et al. 2017

Int J Colorectal Dis

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“…Male sex and SSI after primary surgery are independent risk factors for developing wound infections [ 22 ]. One recent study suggested that purse-string skin closure is an effective technique for reducing the incidence of superficial SSI [ 23 ]. The higher wound infection and total complication rate after ileostomy closure in our study was due to the inclusion of not only deep but also superficial SSIs.…”

Section: Discussionmentioning

confidence: 99%

Early closure of defunctioning stoma increases complications related to stoma closure after concurrent chemoradiotherapy and low anterior resection in patients with rectal cancer

et al. 2017

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BackgroundAfter a low anterior resection, creating a defunctioning stoma is vital for securing the anastomosis in low-lying rectal cancer patients receiving concurrent chemoradiotherapy. Although it decreases the complication and reoperation rates associated with anastomotic leakage, the complications that arise before and after stoma closure should be carefully evaluated and managed.MethodsThis study enrolled 95 rectal cancer patients who received neoadjuvant concurrent chemoradiotherapy and low anterior resection with anastomosis of the bowel between July 2010 and November 2012. A defunctioning stoma was created in 63 patients during low anterior resection and in another three patients after anastomotic leakage.ResultsThe total complication rate from stoma creation to closure was 36.4%. Ileostomy led to greater renal insufficiency than colostomy did and significantly increased the readmission rate (all p < 0.05). The complication rate related to stoma closure was 36.0%. Patients with ileostomy had an increased risk of developing complications (p = 0.017), and early closure of the defunctioning stoma yielded a higher incidence of morbidity (p = 0.006). Multivariate analysis revealed that a time to closure of ≤109 days was an independent risk factor for developing complications (p = 0.007).ConclusionsThe optimal timing of stoma reversal is at least 109 days after stoma construction in rectal cancer patients receiving concurrent chemoradiotherapy and low anterior resection.

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“…The fascia defect was closed primarily with either continuous or interrupted absorbable sutures. The skin was closed using a purse‐string technique. All procedures were performed or supervised by one of four experienced gastrointestinal surgeons.…”

Section: Methodsmentioning

confidence: 99%

Incidence of and risk factors for stoma-site incisional herniation after reversal

et al. 2018

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BackgroundStoma reversal is often considered a straightforward procedure with low short‐term complication rates. The aim of this study was to determine the rate of incisional hernia following stoma reversal and identify risk factors for its development.MethodsThis was an observational study of consecutive patients who underwent stoma reversal between 2009 and 2015 at a teaching hospital. Patients followed for at least 12 months were eligible. The primary outcome was the development of incisional hernia at the previous stoma site. Independent risk factors were assessed using multivariable logistic regression analysis.ResultsAfter a median follow‐up of 24 (range 12–89) months, 110 of 318 included patients (34·6 per cent) developed an incisional hernia at the previous stoma site. In 85 (77·3 per cent) the hernia was symptomatic, and 72 patients (65·5 per cent) underwent surgical correction. Higher BMI (odds ratio (OR) 1·12, 95 per cent c.i. 1·04 to 1·21), stoma prolapse (OR 3·27, 1·04 to 10·27), parastomal hernia (OR 5·08, 1·30 to 19·85) and hypertension (OR 2·52, 1·14 to 5·54) were identified as independent risk factors for the development of incisional hernia at the previous stoma site. In addition, the risk of incisional hernia was greater in patients with underlying malignant disease who had undergone a colostomy than in those who had had an ileostomy (OR 5·05, 2·28 to 11·23).ConclusionIncisional hernia of the previous stoma site was common and frequently required surgical correction. Higher BMI, reversal of colostomy in patients with an underlying malignancy, stoma prolapse, parastomal hernia and hypertension were identified as independent risk factors.

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Comparison of surgical techniques for stoma closure: A retrospective study of purse-string skin closure versus conventional skin closure following ileostomy and colostomy reversal

Cited by 14 publications

References 13 publications

Temporary closure of colostomy with suture before colostomy takedown improves the postoperative outcomes

Temporary closure of colostomy with suture before colostomy takedown improves the postoperative outcomes

Early closure of defunctioning stoma increases complications related to stoma closure after concurrent chemoradiotherapy and low anterior resection in patients with rectal cancer

Incidence of and risk factors for stoma-site incisional herniation after reversal

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