Purse-string skin closure versus linear skin closure techniques in stoma closure: a comprehensive meta-analysis with trial sequential analysis of randomised trials

Abstract

PSC is associated with significantly lower risk of SSI and better patient satisfaction compared with LSC in closure of stomas and should be the closure technique of choice. The current available evidence is robust and conclusive highlighting that the results of the current study should be incorporated into clinical practice without a need for further trial data.

Closed-Wound Negative Pressure Therapy Dressing After Loop Ostomy Closure.

“…The main advantage probably consists in simpli ed post-operative wound care, unlike the time-consuming purse-string closure. While several reports revealed lower SSI rates after purse-string closure compared to primary closure [4,5], wounds require daily care until discharge and specialist wound care for about 35 days according to our institutional experience (4) and a previous report [14]. In contrast, primarily closed ostomy wounds without SSI occurrence typically heal within 7-24 days [4,9].…”

“…Among various skin closure techniques for ostomy wounds [3], purse-string closure has shown superiority in reducing SSI compared to primary skin closure [4][5][6]. Nevertheless, purse-string wounds take longer to heal than primary closure techniques and require daily wound care [4].…”

Routine practice needs shifting from linear to purse-string skin closure in closure of stoma sites

“…We know from the available evidence that primary skin closure at the stoma reversal site with or without a subcutaneous drain is associated with higher risk of surgical site infection (SSI) in comparison with purse-string skin closure [2]. Although primary skin closure with use of a subcutaneous drain resulted in lower risk of SSI (8.6%) compared with primary skin closure without a drain (15.0%) in the study by Neumann et al 1 , the reported risks are higher than the risk of SSI associated with purse-string skin closure (2.5%) [2]. Whether the use of the purse-string skin closure technique together with a subcutaneous drain results in a still lower risk of SSI in comparison with purse-string skin closure without a drain remains unanswered.…”

Early versus Routine Stoma Closure in Patients With Colorectal Resection: A Meta-Analysis of 7 Randomized Controlled Trials

“…3 Another study have compared primary closure of ileostomy wounds with delayed primary closure wound packing or closure over a drain, 4 The infection rate was 10% for primary closure and 20% for delayed primary closure. We also read with interest the article by Shahab Hajibandeh et al, 5 which was published online on August 3, 2018, in the International Journal of Colorectal Disease. The authors confirmed that purse-string skin closure is associated with a significantly lower risk of surgical site infection compared with linear skin closure in the closure of stomas.…”