Gunsight Procedure Versus the Purse-String Procedure for Closing Wounds After Stoma Reversal: A Multicenter Prospective Randomized Trial

Comparison of modified gunsight suture technique and traditional interrupted suture in enterostomy closure

BACKGROUND

Prophylactic enterostomy surgery is a common surgical approach used to reduce the risk of anastomotic leakage in patients who have undergone partial intestinal resection due to trauma or tumors. However, the traditional interrupted suturing technique used in enterostomy closure surgery has several issues, including longer surgical incisions and higher incision tension, which can increase the risk of postoperative complications. To address these issues, scholars have proposed the use of a "gunsight suture" technique. This technique involves using a gunsight incision instead of a traditional linear incision, leaving a gap in the center for the drainage of blood and fluid to reduce the risk of infection. Building on this technique, we propose an improved gunsight suture technique. A drainage tube is placed at the lowest point of the incision and close the gap in the center of the gunsight suture, which theoretically facilitates early postoperative mobility and reduces the burden of dressing changes, thereby reducing the risk of postoperative complications.

AIM

To compare the effectiveness of improved gunsight suture technique with traditional interrupted suture in closing intestinal stomas.

METHODS

In this study, a retrospective, single-center case analysis was conducted on 270 patients who underwent prophylactic ileostomy closure surgery at the Department of Colorectal Surgery of Qilu Hospital from April 2017 to December 2021. The patients were divided into two groups: 135 patients received sutures using the improved gunsight method, while the remaining 135 patients were sutured with the traditional interrupted suture method. We collected data on a variety of parameters, such as operation time, postoperative pain score, body temperature, length of hospital stays, laboratory indicators, incidence of incisional complications, number of wound dressing changes, and hospitalization costs. Non-parametric tests and chi-square tests were utilized for data analysis.

RESULTS

There were no statistically significant differences in general patient information between the two groups, including the interval between the first surgery and the stoma closure [132 (105, 184) d vs 134 (109, 181) d, P = 0.63], gender ratio (0.64 vs 0.69, P = 0.44), age [62 (52, 68) years vs 60 (52, 68) years, P = 0.33], preoperative body mass index (BMI) [23.83 (21.60, 25.95) kg/m² vs 23.12 (20.94, 25.06) kg/m², P = 0.17]. The incidence of incision infection in the improved gunsight suture group tended to be lower than that in the traditional interrupted suture group [ (n = 2/135, 1.4%) vs (n = 10/135, 7.4%), P < 0.05], and the postoperative hospital stay in the improved gunsight suture group was significantly shorter than that in the traditional interrupted suture group [5 (4, 7) d vs 7 (6, 8) d, P < 0.05]. Additionally, the surgical cost in the modified gunsight suture group was slightly lower than that in the traditional suture group [4840 (4330, 5138) yuan vs 4980 (4726, 5221) yuan, P > 0.05], but there was no significant difference in the total hospitalization cost between the two groups.

CONCLUSION

In stoma closure surgery, the improved gunsight technique can reduce the incision infection rate, shorten the postoperative hospital stay, reduce wound tension, and provide better wound cosmetic effects compared to traditional interrupted suture.

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

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.