Wound infection following stoma reversal: a prospective comparative study between primary closure and partial closure with intervening silver dressings

Zubaidah, Nanik; Soo, Jia Ying; Qisti, N.; Ong, Kang Woei; Gee, Tikfu

doi:10.1007/s00384-015-2487-0

Cited by 6 publications

(2 citation statements)

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“…13 A more recent prospective randomized trial evaluated interrupted linear closure interleaved with a silver dressing and reported 0% SSI compared to patients with primary closure, although the difference was not statistically signi cant. 15 A small prospective study comparing primary closure to purse string closure packed with moistened gauze demonstrated a decreased SSI rate but the additive effect of the additional dressing is unknown. 16 A meta-analysis of studies utilizing negative pressure wound therapy for stoma closure demonstrated a reduction of SSIs but the conclusions are limited by the combination technique of several included studies where negative pressure was utilized in addition to purse-string closure.…”

Section: Discussionmentioning

confidence: 99%

Infectious complications after modified purse-string stoma closure

Hao,

Bridges,

Sutton

et al. 2023

Preprint

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Purpose: Current society guidelines recommend purse-string closure technique for stoma reversal, which has been shown to reduce but not eliminate the risk of deep surgical site infection (SSI) at the original stoma site, a complication associated with increased morbidity and cost. We studied an adjunctive technique to further reduce the risk of SSI. Methods: A retrospective chart review was conducted on adult patients who underwent stoma reversal between May 2016 - July 2022. Stoma reversal was performed with purse-string closure, and placement of a strip of povidone-iodine soaked non-adherent pad in the remaining two cm opening at the prior stoma site. This pad was taken out on post-operative day one and changed to wet-to-dry saline moistened gauze. Results: 82 patients were identified. The cohort had a median BMI 26.5 [IQR 23.0-31.0] and median age 57.5 [IQR 45.8-67.0]. Mean time from original surgery to reversal was nine months. 59.8% identified as female, 24.4% were currently smoking, 18.3% were had diabetes. The cohort experienced a 11.0% readmission rate and 18.3% rate of stoma site hernia with a mean follow up of 17 months. No patient developed an SSI. Conclusion: In this cohort study with known risk factors for SSI, no patients undergoing stoma reversal experienced a post-operative SSI. The adjunctive technique of a povidone-iodine soaked non-adherent pad in addition to purse-string closure should be further examined in conjunction with surgical bundles to reduce the risk of SSI and overall morbidity of stoma reversal surgery.

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Section: Discussionmentioning

confidence: 99%

Infectious complications after modified purse-string stoma closure

Hao,

Bridges,

Sutton

et al. 2023

Preprint

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“…Closure of a stoma is usually an elective procedure, and it is classified as a clean-contaminated surgery, which means that there is a greater risk of surgical site infection (SSI) in and around the stoma site [8]. Closure of the skin with non-absorbable sutures in a linear fashion after stoma closure has been the traditional method.…”

Section: Introductionmentioning

confidence: 99%

Surgical Site Infection After Stoma Reversal: A Comparison Between Linear and Purse-String Closure

Khan,

Niaz,

Asghar

et al. 2023

Cureus

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Introduction: Intestinal stomas are utilized for both benign and malignant conditions of the intestine to mitigate the risk of anastomotic leakage and re-exploration. However, stomas are associated with various complications, such as stoma necrosis, peri-stomal irritation, parastomal hernia, bleeding, bowel obstruction, and electrolyte abnormalities. Surgical site infection (SSI) is a significant source of morbidity following stoma reversal, leading to increased patient morbidity. The conventional method of stoma reversal involves closing the skin with non-absorbable sutures in a linear fashion, which is known as linear skin closure (LSC). Recently, a new method of skin closure using purse-string approximation (PSA) has been advocated, which allows healing by secondary intention. The rationale for this study is to compare the SSI associated with LSC and PSA after stoma reversal.Objective: This study aims to compare the frequency of SSI between LSC and PSA in stoma reversal.Materials and methods: The study was conducted at the Department of General Surgery, Shifa International Hospitals Ltd. (SIH), Islamabad, Pakistan. The study is a randomized controlled clinical trial carried out between the 14 th of March 2021 and the 22 nd of November 2022. The sampling technique was nonprobability consecutive random sampling. The sample size was calculated using the WHO sample size calculator by using the hypothesis test for two population proportions. The minimum sample size in each group was 40 patients. The total sample size was 80 patients.Results: The overall frequency of SSI in all the patients was 18/80 (22.5%). The frequency of SSI in Group 1 (LSC) was 6/40 (15.0%), and in Group 2 (PSA), it was 12/40 (30.0%). The frequency of SSI in Group 2 (PSA) was twice as high as in Group 1 (LSC); however, the p-value was calculated to be 0.108. Therefore, this difference was statistically insignificant.Conclusions: While PSA has exhibited promise in reducing SSI rates and enhancing aesthetic outcomes and patient satisfaction, there is still enough data favoring LSC. Moreover, insufficient data is available for our population to make a definitive statement. Consequently, further research on this topic is warranted, preferably involving larger sample sizes and multicenter randomized controlled trials, to establish which technique is superior in SSI reduction.

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