Single‐centre experience of loop ileostomy closure: a retrospective comparison of conventional‐linear closure and purse‐string closure on surgical‐site‐infection rates

Abstract

Background The closure of ileostomy is associated with significant morbidity, the most common being surgical site infection (SSI), ranging up to 41%. This study compared the stoma site SSI rates after either the conventional‐linear closure (CLC) or purse‐string closure (PSC). Methods The study conducted a single‐centre retrospective cohort study of elective loop‐ileostomy closures from June 2015 to January 2021. Patient demographics, surgical techniques and outcomes, including SSI rates, were analysed using SPSS ver.27. Results Hundred and six patients underwent loop‐ileostomy closure, 91.5% (n = 97) had CLC of which 67% (n = 65) were stapled. Male patients comprise 67.9%, with a median age of 62. The median BMI was 27. The median surgical time, LOS and interval time to closure were 66 min, 4.5 days and 5.5 months, respectively. The SSI rate was 19.6% (n = 19) for CLC and 11.1% (n = 1) for PSC. The SSI rate was significantly reduced to 3.7% (P < 0.001) in CLC when the site was washed with betadine. Multivariate logistic regression controlled for statistically insignificant confounders showed that stoma site betadine wash was significantly and independently associated with reduced SSI risk (P = 0.026). Other significant factors which reduced SSI risk were prophylactic antibiotic therapy (P = 0.004), operative time < 60 min (P = 0.021), and having the closure done >3 months post the formation surgery (P = 0.040). Conclusions This study found that stoma SSI risk was independently and significantly reduced when CLC stapled site was washed with betadine. This low‐cost intervention that significantly reduced skin closure site SSI rates is readily available and can easily be adopted into clinical practice.

Infectious complications after modified purse-string stoma closure

“…18 The only study to examine povidone-iodine in stoma closure reported a reduction in SSI following loop ileostomy reversal if the stoma site was washed with povidone-iodine prior to primary closure. 19 Development of a stoma site hernia occurs anywhere from 7.4-34.6%. [20][21] Risk factors for stoma site hernia after reversal include presence of a pre-operative parastomal hernia, obesity, reversal of a colostomy rather than an ileostomy, and post-operative SSI.…”