Randomized controlled trial: comparison of two surgical techniques for closing the wound following ileostomy closure: purse string vs direct suture

Abstract

Aim Surgical site infection (SSI) is a common complication following ileostomy closure with a frequency of up to 40%. This prospective randomized controlled trial was initiated to compare two surgical techniquesdirect suture (DS) and purse-string suture (PSS) -used to close the wound following ileostomy closure. The primary end-point was the SSI rate. Secondary endpoints were cosmetic outcome [using two validated scales: the Patient and Observer Scar Assessment Scale (POSAS) and the Body Image Questionnaire (BIQ)] and the influence of other factors on the SSI rate.Method Of a total of 99 patients screened, 84 were included in this study. Forty-three patients were randomized into the PSS group and 41 were randomized into the DS group. Follow up was performed within 3 days after surgery, at discharge, and 30 days and 6 months after the operation.Results In the PSS group there were no cases of SSI compared with 10 (24%) cases in the DS group (P = 0.0004). There were no statistically significant differences in cosmetic outcome between the two groups. No other statistically significant factors influencing the incidence of SSI could be identified. ConclusionThe rate of SSI is significantly lower following PSS than following DS, and both techniques have a similar cosmetic outcome. PSS closure should be considered as standard of care for wound closure after ileostomy reversal.

Pursestring Closure versus Conventional Primary Closure Following Stoma Reversal to Reduce Surgical Site Infection Rate

“…20 a total of 133 records were identified after searching the meDline, emBase, and Cochrane Central Register of Controlled trials databases. after removal of 50 duplicates and 79 exclusions because of the use of unapproved regimens, the lack of placebo or relevant outcomes, 4 RCts with a total of 319 participants were included in this meta-analysis: Reid et al, 21 Dusch et al, 22 Camacho-mauries et al, 23 and lee et al 24 Study Characteristics the characteristics of the included trials are summarized in table 1. these trials were published between 2010 and 2014. the sample size ranged from 61 to 113, with a total of 319 participants (162 in the PsC group and 157 in the CPC group). none of the 4 trials was double-blind.…”

“…all participants in all 4 trials received preoperative prophylactic antibiotics, but no postoperative antibiotic use was reported. fascia closure was achieved with 1-0 polydioxanone suture in Reid's trial, 21 2-0 Vicryl in Dusch's trial, 22 and 1-0 Vicryl in Camacho-mauries' trial. 23 for the skin closure material of the PsC group, nonabsorbable Prolene was placed and then cinched to a 4-to 20-mm opening orifice in 3 trials, [21][22][23] and absorbable monocryl was used in lee's trial.…”

“…there were no significant differences in the operative time and length of hospital stay between the PsC and CPC groups. 21 Dusch et al, 22 and Camacho-mauries et al 23 however, the 3 RCts recruited a small number of participants, with only 105 in the PsC group and 101 in the CPC group. Besides, only 3 outcomes, ssi, operative time, and length of hospital stay, were analyzed with no assessments on wound healing time and cosmetic outcomes.…”

“…the participants and surgeons were aware of the operative method and allocated group because the skin closure methods and wound pattern differed substantially between these groups. in the trials of Dusch et al 22 and lee et al, 24 the wound assessors were the participating surgeons, whereas the wound assessors were the independent well-trained personnel in the Reid trial. 21 although the "independent" wound assessors had been trained to evaluate ssi objectively, a high risk of bias could not be excluded because the assessors were aware of the allocated group by examining the wound appearance, which might have influenced their judgment of ssi.…”

Negative-Pressure Therapy to Reduce the Risk of Wound Infection Following Diverting Loop Ileostomy Reversal

“…1 However, the postoperative morbidity following intestinal ostomy takedown ranges from 0% to 40%, 2,3 with surgical site infection (SSI) as the most common complication. 4 An adequate treatment of SSI can be achieved by local drainage, wound cleaning, and antibiotics, but the cosmetic results can be unsatisfactory, and typically, this is associated with an increased risk of incisional hernias and a prolonged hospital stay. 5 In recent years, many techniques have attempted to improve SSI rates in colorectal surgery, 6,7 especially regarding stoma-related complications.…”