Negative-pressure wound therapy after stoma reversal in colorectal surgery: a randomized controlled trial

Abstract

Background Stoma-reversal surgery is associated with high postoperative morbidity, including wound complications and surgical-site infections (SSIs). This study aims to assess whether the application of negative-pressure wound therapy (NPWT) can improve wound healing compared with conventional wound dressing. Methods This was a single-centre, superiority, open-label, parallel, individually randomized controlled trial. Patients undergoing stoma reversal were randomized (1 : 1) to receive NPWT or conventional wound dressing. The primary endpoint of the study was the rate of wound complications and SSIs after stoma closure. The secondary endpoints were postoperative wound pain, rate of wound healing after 30 days from stoma closure, and wound aesthetic satisfaction. Results Between June 2019 and January 2021, 50 patients were allocated to the NPWT group (all received NPWT, 49 were analysed); 50 patients were allocated to the conventional wound dressing group (48 received the treatment, 45 were analysed). No significant difference was found in wound-complication rate (10 per cent NPWT versus 16 per cent controls; odds ratio 0.61 (95 per cent c.i. 0.18 to 2.10), P = 0.542) and incisional SSI rate (8 per cent NPWT versus 7 per cent controls; odds ratio 1.24 (95 per cent c.i. 0.26 to 5.99), P = 1.000). The NPWT group showed less pain, higher aesthetic satisfaction (P < 0.0001), and a higher proportion of wound healing (92 versus 78 per cent; P = 0.081) compared with the control group. Conclusion NPWT does not reduce the incidence of SSI after stoma-reversal surgery compared with conventional wound dressing. However, NPWT improved the healing of uninfected wounds, reduced wound pain and led to better aesthetic outcomes. Registration number: NCT037812016 (clinicaltrials.gov).

Post‐operative nursing activities to prevent wound complications in patients undergoing colorectal surgeries: A scoping review

“…Some of the most common surgical procedures that patients underwent were low anterior resection, colectomy and abdominoperineal resection (see Table 2). Most interventions were delivered in academic (Arslan et al., 2020; Chadi et al., 2014; Cima et al., 2013; Curchod et al., 2022; Curran et al., 2019; Forsmo et al., 2016; Han et al., 2021; Keenan et al., 2014, 2015; Martinez et al., 2020; Pan et al., 2015; Park et al., 2020; Poehnert et al., 2017; Tanner et al., 2016; Wierdak et al., 2021) and tertiary facilities (Carrano et al., 2021; Chadi et al., 2014; Cima et al., 2013; D'Souza et al., 2019; Keenan et al., 2014, 2015; Martinez et al., 2020; Ocaña Jiménez et al., 2019; Park et al., 2020; Poehnert et al., 2017; Wierdak et al., 2021). The units where interventions/quality improvement initiatives were delivered were surgical (Hewitt et al., 2017; Pellino, Sciaudone, Candilio, de Fatico, et al., 2014; Selvaggi et al., 2014; Watanabe et al., 2017), colorectal (Gorgun et al., 2018; Pan et al., 2015; Shakeshaft et al., 2020), gastroenterology (Han et al., 2021) and general surgical units (Arslan et al., 2020).…”

“…The most frequent interventions/quality improvement initiatives were negative pressure wound pressure therapy (NWPT) (Abadía et al., 2021; Borejsza‐Wysocki et al., 2021; Carrano et al., 2021; Chadi et al., 2014; Curchod et al., 2022; Curran et al., 2019; León Arellano et al., 2021; Murphy et al., 2019; Ocaña Jiménez et al., 2019; Okuya et al., 2020; Pellino, Sciaudone, Candilio, Campitiello, et al., 2014; Pellino, Sciaudone, Candilio, de Fatico, et al., 2014; Poehnert et al., 2017; Selvaggi et al., 2014; Uchino et al., 2016; Webb et al., 2019; Wierdak et al., 2021) and SSI bundles (Cima et al., 2013; D'Souza et al., 2019; Gorgun et al., 2018; Hewitt et al., 2017; Keenan et al., 2014, 2015; Martinez et al., 2020; Park et al., 2020; Reese et al., 2020; Tanner et al., 2016). We found no interventions/quality improvement initiatives with nursing activities exclusively occurring in the postoperative phase; activities also occurred in the pre‐ and intraoperative phases, and all interventions/quality improvement initiatives had multidisciplinary input (see Table 3).…”

“…‘Technical procedure and delegated medical care’ was the most frequent dimension of care undertaken by nurses ( n = 63 activities) (see Table 5). Within this domain, wound management activities were common, such as removal of NWPT (Abadía et al., 2021; Carrano et al., 2021; Chadi et al., 2014; Curchod et al., 2022; Curran et al., 2019; León Arellano et al., 2021; Murphy et al., 2019; Ocaña Jiménez et al., 2019; Okuya et al., 2020; Pellino, Sciaudone, Candilio, Campitiello, et al., 2014; Pellino, Sciaudone, Candilio, de Fatico, et al., 2014; Poehnert et al., 2017; Selvaggi et al., 2014; Uchino et al., 2016; Webb et al., 2019; Wierdak et al., 2021), removal of other dressings (Ahmad et al., 2019; Cima et al., 2013; D'Souza et al., 2019; Gorgun et al., 2018; Hewitt et al., 2017; Keenan et al., 2014, 2015; Park et al., 2020; Reese et al., 2020; Ruiz‐Tovar et al., 2015; Ruiz‐Tovar et al., 2019; Siah & Yatim, 2011), dressing changes (Borejsza‐Wysocki et al., 2021; Pan et al., 2015; Pellino, Sciaudone, Candilio, Campitiello, et al., 2014; Pellino, Sciaudone, Candilio, de Fatico, et al., 2014; Selvaggi et al., 2014; Siah & Yatim, 2011; Wierdak et al., 2021) and removal of staples and sutures (León Arellano et al., 2021; Pan et al., 2015; Siah & Yatim, 2011; Wierdak et al., 2021) (see Table 3). Dressing removal activities ranged from postoperative day (POD) 2 to POD 14.…”

Application of PREVENA (Surgical Incision Protection System) in reducing surgical site infections following reversal of ileostomy or colostomy: the PRIC study protocol

“…Uchino et al also noted no difference in the efficacy rates between the use of NPWT and pursestring suture methods in preventing SSI [21]. Similarly, Carrano et al reported similar incidence rates of SSI and wound complications in both the NPWT and conventional dressing cohorts [22]. In contrast, the trial conducted by Wierdak et al reported a positive benefit in the use of prophylactic NPWT in the setting of ileostomy closure, with a reduced incidence of SSI and wound healing complications.…”

The effectiveness of negative pressure wound therapy compared to the traditional method in the treatment of diabetic foot

“…Terapia podciśnieniowa jest stosowana także w licznych zabiegach chirurgii jamy brzusznej. W przypadku operacji odwrócenia stomii grupa badanych u których zastosowano NPWT wykazała lepsze gojenie się ran, mniejszy ból i większe zadowolenie z estetyki niż grupa u której stosowano inne metody opatrywania rany [10] . Z kolei w pierwotnym zamknięciu powięzi na otwartym brzuchu bez urazu, NPWT w porównaniu do innej metodyworka Bogota -nie okazała się być metodą bardziej innowacyjną [11].…”