Randomized clinical trial of short-term outcomes following purse-string versus conventional closure of ileostomy wounds

Abstract

ACTRN12609000021279 (Australian New Zealand Clinical Trials Registry: http://www.anzctr.org.au/).

Prevalence of Surgical Site Infection at the Stoma Site following Four Skin Closure Techniques: A Retrospective Cohort Study

“…However, we reported a higher rate of SSI in the PC subgroup (42%) compared to the range described in prior studies (3-39%) [4,9,17,18,19]. This may be explained by differences in the definition of SSI compared to older studies and the relatively sicker population in our cohort.…”

“…Compared to another study that used CDC definitions, we noted that our sample population is older, more comorbid (higher ASA score), and with higher BMI [10]. One of two contemporary studies that use the CDC guidelines had one observer assess all SSI events [9]; due to the retrospective nature of our study, it was not feasible for our study to duplicate this.…”

“…We reported a 22% rate of stoma site SSI, which is within the range of 8-38% that is reported among studies that use similar CDC guideline definitions [9,10,15]. Studies that predate the CDC guidelines reported a wider range from 2 to 41%, which may reflect the variation in SSI definition before the guidelines were established.…”

“…Several retrospective studies found that secondary closure (SC), delayed PC, and loose PC (LPC) are superior to PC [5,6,7]. Recently, some have investigated the role of circular closure (CC), or purse-string closure, and found lower rates of SSI in wounds closed with CC compared to PC [8,9,10]. However, most of these studies are small, with less than 80 patients, and compare CC with PC only.…”

Randomized Controlled Trial of Prophylactic Negative-Pressure Wound Therapy at Ostomy Closure for the Prevention of Delayed Wound Healing and Surgical Site Infection in Patients with Ulcerative Colitis

“…However, ileostomy closure is classified as a class 3 wound, suggesting highly contaminated wounds and wound infection [7] . Several clinical trials comparing a purse-string suture (PSS) and conventional linear closure have been performed, demonstrating advantages for PSS in avoiding surgical site infection (SSI) [8,9] . Although the efficacy of PSS is widely recognized, delayed wound healing consecutive to SSI can still develop after ostomy closure.…”