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Carannante F, Costa G, Miacci V, Bianco G, Masciana G, Lauricella S, Caricato M, Capolupo GT. Comparison of purse-string technique vs linear suture for skin closure after ileostomy reversal. A randomized controlled trial. Langenbecks Arch Surg 2024; 409:141. [PMID: 38676785 DOI: 10.1007/s00423-024-03332-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 04/23/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Protective stoma after rectal surgery has been associated with important complications. The most common is surgical site infection (SSI) high rates after stoma reversal reported in literature. Our study compared the rate of SSI of two skin closure techniques, linear closure, and purse string closure. METHODS We carried out a single center, prospective, randomized controlled trial in the Department of Colorectal Surgery of Fondazione Policlinico Campus Bio-Medico of Rome between January 2018 through December 2021, to compare LC vs PS closure of ileostomy sites. RESULTS A total of 117 patients (53.84% male) with a mean age of 65.68 ± 14.33 years were finally evaluated in the study. 58 patients were included in the PS group and 59 patients in the LC one. There was a marked difference in the SSI rate between the two arms of the study: 3 of 58 patients in the purse-string arm versus 11 of 59 in the control arm (p = 0.043). The outcome of cosmesis was also higher in PS, with a statistical significance (mean ± DS 4,01 ± 0,73 for PS group vs mean ± DS 2,38 ± 0,72 for LC group, p < 0,001). CONCLUSION Our study demonstrated that the PS technique had a significantly lower incidence of stoma site SSI compared with LC technique. Our findings are in line with other randomized studies and suggest that PS closure could be considered as standard of care for wound closure after ileostomy reversal.
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Affiliation(s)
- Filippo Carannante
- Colorectal Surgery Clinical and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico Di Roma, University Campus Bio-Medico, Via Àlvaro del Portillo 200, 00128, Rome, Italy.
- Università Campus Bio-Medico Di Roma, Via Àlvaro del Portillo 200, 00128, Rome, Italy.
| | - Gianluca Costa
- Colorectal Surgery Clinical and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico Di Roma, University Campus Bio-Medico, Via Àlvaro del Portillo 200, 00128, Rome, Italy
| | - Valentina Miacci
- Colorectal Surgery Clinical and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico Di Roma, University Campus Bio-Medico, Via Àlvaro del Portillo 200, 00128, Rome, Italy
- Università Campus Bio-Medico Di Roma, Via Àlvaro del Portillo 200, 00128, Rome, Italy
| | - Gianfranco Bianco
- Colorectal Surgery Clinical and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico Di Roma, University Campus Bio-Medico, Via Àlvaro del Portillo 200, 00128, Rome, Italy
- Università Campus Bio-Medico Di Roma, Via Àlvaro del Portillo 200, 00128, Rome, Italy
| | - Gianluca Masciana
- Colorectal Surgery Clinical and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico Di Roma, University Campus Bio-Medico, Via Àlvaro del Portillo 200, 00128, Rome, Italy
| | - Sara Lauricella
- Tumori Ereditari Dell'Apparato Digerente, Chirurgia Generale Oncologica 2 - Colon-Retto, Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Venezian 1, 20133, Milano, Italy
| | - Marco Caricato
- Colorectal Surgery Clinical and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico Di Roma, University Campus Bio-Medico, Via Àlvaro del Portillo 200, 00128, Rome, Italy
- Università Campus Bio-Medico Di Roma, Via Àlvaro del Portillo 200, 00128, Rome, Italy
| | - Gabriella Teresa Capolupo
- Colorectal Surgery Clinical and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico Di Roma, University Campus Bio-Medico, Via Àlvaro del Portillo 200, 00128, Rome, Italy
- Università Campus Bio-Medico Di Roma, Via Àlvaro del Portillo 200, 00128, Rome, Italy
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Xu DY, Bai BJ, Shan L, Wei HY, Lin DF, Wang Y, Wang D. Micro-power negative pressure wound technique reduces risk of incision infection following loop ileostomy closure. World J Gastrointest Surg 2024; 16:186-195. [PMID: 38328332 PMCID: PMC10845270 DOI: 10.4240/wjgs.v16.i1.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/30/2023] [Accepted: 12/13/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Prophylactic loop ileostomy is an effective way to reduce the clinical severity of anastomotic leakage following radical resection of rectal cancer. Incisional surgical site infection (SSI) is a common complication after ileostomy closure. AIM To evaluate the efficacy and safety of the micro-power negative pressure wound technique (MPNPWT) in preventing incisional SSI. METHODS This was a prospective, randomized controlled clinical trial conducted at a single center. A total of 101 consecutive patients who underwent ileostomy closure after rectal cancer surgery with a prophylactic ileostomy were enrolled from January 2019 to December 2021. Patients were randomly allocated into an MPNPWT group and a control group. The MPNPWT group underwent intermittent suturing of the surgical incision with 2-0 Prolene and was covered with a micro-power negative pressure dressing. The surgical outcomes were compared between the MPNPWT (n = 50) and control (n = 51) groups. Risk factors for incisional SSI were identified using logistic regression. RESULTS There were no differences in baseline characteristics between the MPNPWT (n = 50) and control groups (n = 51). The incisional SSI rate was significantly higher in the control group than in the MPNPWT group (15.7% vs 2.0%, P = 0.031). However, MPNPWT did not affect other surgical outcomes, including intra-abdominal complications, operative time, and blood loss. Postoperative hospital stay length and hospitalization costs did not differ significantly between the two groups (P = 0.069 and 0.843, respectively). None of the patients experienced adverse effects of MPNPWT, including skin allergy, dermatitis, and pain. MPNPWT also helped heal the infected incision. Our study indicated that MPNPWT was an independent protective factor [odds ratio (OR) = 0.005, P = 0.025)] and diabetes was a risk factor (OR = 26.575, P= 0.029) for incisional SSI. CONCLUSION MPNPWT is an effective and safe way to prevent incisional SSI after loop ileostomy closure.
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Affiliation(s)
- Deng-Yong Xu
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Bing-Jun Bai
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Lina Shan
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Hui-Yan Wei
- Department of Wound & Ostomy Care Clinic, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Deng-Feng Lin
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Ya Wang
- Department of Hospital Infection Control, Zhejiang Cancer Hospital, Hangzhou 310005, Zhejiang Province, China
| | - Da Wang
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
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Kaistha S, Panwar R, Pal S, Dash NR, Sahni P, Chattopadhyay TK. Wound Infection After Ileostomy Closure: An Interim Analysis of a Prospective Randomized Study Comparing Primary Versus Circumferential Subcuticular Closure Techniques. Surg Infect (Larchmt) 2023; 24:797-802. [PMID: 37856166 DOI: 10.1089/sur.2023.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
Background: Circumferential subcuticular wound approximation (CSWA) of round shaped skin wounds after ileostomy take down is believed to lower the rates of surgical site infection (SSI). We performed this randomized trial to compare the rates of SSI and other short-term outcomes among primary linear skin closure (PC) and CSWA groups of patients. Patients and Methods: All patients undergoing ileostomy reversal during the study period were randomly assigned to either PC or CSWA. The primary outcome was the incidence of SSI as assessed by ASEPSIS scoring system. The secondary outcomes included healing time, length of post-operative hospital stay, and patients' satisfaction regarding cosmetic outcome, expectations, pain, time of healing, wound care, and activity on a five-point Likert scale. Results: Thirty-one patients (PC = 15; CSWA = 16) underwent ileostomy reversal during the study period. There was no SSI in the PC group whereas three patients developed SSI in the CSWA group but the result was not statistically significant (p = 0.23). The scores for time of healing (p < 0.001), wound care (p = 0.007), and activity (p < 0.001) were significantly better for PC compared with CSWA whereas there was no significant difference in the scores for cosmetic outcome, expectations, and pain. Healing time was shorter in the PC group (6.7 vs. 34.2 days; p < 0.001) whereas the post-operative length of stay was comparable (6.3 vs. 7 days; p = 0.27). Conclusions: Although there was no difference in the incidence of SSI among the two groups, the PC group fared better in terms of mean time to healing and requirement of wound care.
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Affiliation(s)
- Sumesh Kaistha
- Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Panwar
- Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India
| | - Sujoy Pal
- Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India
| | - Nihar Ranjan Dash
- Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India
| | - Peush Sahni
- Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India
| | - Tushar Kanti Chattopadhyay
- Department of Gastrointestinal Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India
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Chen C, Zhang X, Cheng ZQ, Zhang BB, Li X, Wang KX, Dai Y, Wang YL. Comparison of modified gunsight suture technique and traditional interrupted suture in enterostomy closure. World J Gastroenterol 2023; 29:4571-4579. [PMID: 37621751 PMCID: PMC10445006 DOI: 10.3748/wjg.v29.i29.4571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023] Open
Abstract
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.
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Affiliation(s)
- Chang Chen
- Department of Colorectal Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
| | - Xiang Zhang
- Department of Colorectal Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
| | - Zhi-Qiang Cheng
- Department of Colorectal Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
| | - Bin-Bin Zhang
- Department of Nursing, Qilu Hospital of Shandong University De Zhou Hospital, Dezhou 254300, Shandong Province, China
| | - Xin Li
- Department of General Surgery, Huantai Branch of Qilu Hospital of Shandong University, Zibo 255000, Shandong Province, China
| | - Ke-Xin Wang
- Department of Colorectal Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
| | - Yong Dai
- Department of Colorectal Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
| | - Yan-Lei Wang
- Department of Colorectal Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
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5
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Askarpour S, Peyvasteh M, Farhadi F, Javaherizadeh H. COMPARISON BETWEEN OSTOMY CLOSURE USING PURSE-STRING VERSUS LINEAR IN CHILDREN. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2022; 35:e1709. [PMID: 36542007 PMCID: PMC9767420 DOI: 10.1590/0102-672020220002e1709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/28/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Type of ostomy closure has connection with some complications and also cosmetic effects. AIMS This study aimed to compare result of colostomy closure using purse-string method versus linear method in terms of surgical site infection, surgical time, and patient satisfaction. METHODS In this study, 50 patients who underwent purse-string ostomy closure and 50 patients who underwent linear closure were included. Two groups were compared for surgical time, wound infection, patient satisfaction, scar length. A p-value <0.05 was considered significant. RESULTS Wound infection was not reported among purse-string group compared to 10% in linear group (p=0.022). Scar length was 24.09±0.1 mm in purse string and 52.15±1.0 mm in linear group (p=0.033). Duration of hospital admission was significantly shorter in purse-string group (6.4±1.1 days) compared to linear (15.5±4.6 days, p=0.0001). The Patient and Observer Scar Assessment Scale scale for observer (p=0.038) and parents (p=0.045) was more favorable among purse-string group compared to linear. CONCLUSION Purse-string technique has the less frequent surgical site infection, shorter duration of hospital admission, less scar length, and more favorable cosmetic outcome, compared to linear technique.
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Affiliation(s)
- Shahnam Askarpour
- Pediatric Surgery, Ahvaz Jundishapur University of Medical Sciences – Ahvaz, Khouzestan, Iran;,Alimentary Tract Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences – Ahvaz, Khouzestan, Iran
| | - Mehran Peyvasteh
- Pediatric Surgery, Ahvaz Jundishapur University of Medical Sciences – Ahvaz, Khouzestan, Iran
| | - Farbod Farhadi
- Pediatric Surgery, Ahvaz Jundishapur University of Medical Sciences – Ahvaz, Khouzestan, Iran
| | - Hazhir Javaherizadeh
- Alimentary Tract Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences – Ahvaz, Khouzestan, Iran
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Masumori K, Maeda K, Hanai T, Sato H, Koide Y, Matsuoka H, Katsuno H, Endo T, Cheong Y, Uyama I. Usefulness of vacuum-assisted closure after stoma closure with purse string suturing: a retrospective trial. FUJITA MEDICAL JOURNAL 2022; 8:67-72. [PMID: 35949515 PMCID: PMC9358675 DOI: 10.20407/fmj.2021-007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/13/2021] [Indexed: 11/22/2022]
Abstract
Objectives Surgical site infection (SSI) is a problematic complication after stoma closure. The purse string suture (PSS) technique eliminates this problem, but the area takes longer to heal. The present retrospective study was performed to evaluate the usefulness of a vacuum-assisted closure (VAC) system for the promotion of wound healing after stoma closure. Methods Consecutive patients undergoing stoma closure with the PSS technique were divided into two groups: those treated with and without use of the VAC system. The volume of dead space and the size of the wound were measured after stoma closure in both groups. The same measurements were performed on days 3 and 7 after closure. The time needed for wound closure was also examined in both groups. Outcomes were also evaluated according to age, body mass index, operative time, bleeding volume, wound consistency, patient satisfaction, perioperative inflammatory response, occurrence of SSI, and hospitalization days. Results The VAC group comprised 31 patients, and the non-VAC group comprised 34 patients. The volume of dead space on days 3 and 7 after closure was significantly smaller in the VAC group than in the non-VAC group (P=0.006 and P<0.001, respectively). The number of SSIs was significantly lower in the VAC group than in the non-VAC group (P=0.014). Conclusion The dead space volume on days 3 and 7 after stoma closure with PSS significantly decreased by using the VAC system. The incidence of SSI after stoma closure also significantly decreased by using the VAC system.
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Affiliation(s)
- Koji Masumori
- Department of Gastroenterological Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Kotaro Maeda
- International Medical Center, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Tsunekazu Hanai
- Department of Gastroenterological Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Harunobu Sato
- Department of Gastroenterological Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Yoshikazu Koide
- Department of Gastroenterological Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Hiroshi Matsuoka
- Department of Gastroenterological Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Hidetoshi Katsuno
- Department of Gastroenterological Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Aichi, Japan
| | - Tomoyoshi Endo
- Department of Gastroenterological Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Aichi, Japan
| | - Yeongcheol Cheong
- Department of Gastroenterological Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Ichiro Uyama
- Department of Gastroenterological Surgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
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Sayuen C, Phannua R, Chusilp S, Tanming P, Areemit S, Decharun K, Vejchapipat P, Thaiwatcharamas K. A comparison of surgical site infections in children after stoma reversal between purse-string and linear closure. Pediatr Surg Int 2022; 38:149-156. [PMID: 34546402 DOI: 10.1007/s00383-021-05011-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND To reduce the surgical site infections (SSI), the purse-string closure technique has been widely performed and has also been recommended in adult stoma reversal. However, for children, some debate still exists. This study aims to compare the SSI rates in children between the purse-string and the linear for the skin closure of stoma reversal. METHODS The data were collected from pediatric patients, who had undergone either purse-string or linear closure for elective surgery of stoma reversal from two university hospitals between January 2016 and December 2019. RESULTS The purse-string and linear closure had been performed on 31 and 45 patients, respectively. At 30 days after surgery, three patients in the purse-string closure group had developed SSI compared to 14 patients in the linear closure group (9.7 vs. 31.1%, p = 0.028). Furthermore, there had been no significant difference in the overall post-operative complications. In multivariate analysis, the SSI had been significantly lower in patients with purse-string closure (OR 0.21, 95% CI 0.05-0.86, p = 0.029). CONCLUSION By employing the purse-string closure technique for skin closure of stoma reversal, there had been a significantly lower SSI rate compared to linear closure with no difference in the length of hospital stay.
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Affiliation(s)
- Chanathip Sayuen
- Department of Surgery, Khon Kaen University, Khon Kaen, 40002, Thailand.,Department of Surgery, Roi-Et Hospital, Roi-Et, 45000, Thailand
| | | | - Sinobol Chusilp
- Department of Surgery, Khon Kaen University, Khon Kaen, 40002, Thailand
| | | | - Suchat Areemit
- Department of Surgery, Khon Kaen University, Khon Kaen, 40002, Thailand
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8
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Li CK, Liang WW, Wang HM, Guo WT, Qin XS, Zhao J, Zhou WB, Li Y, Wang H, Huang RK. Gunsight sutures significantly reduce surgical-site infection after ileostomy reversal compared with linear sutures. Gastroenterol Rep (Oxf) 2021; 9:357-362. [PMID: 34567568 PMCID: PMC8460110 DOI: 10.1093/gastro/goaa075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/21/2020] [Accepted: 03/24/2020] [Indexed: 11/30/2022] Open
Abstract
Background Surgical-site infection (SSI) was one of the most common post-operative morbidities of ileostomy reversal. Although several skin-closure procedures had been developed to reduce the rate of SSI, the optimal procedure remains unclear. In this study, we compared the effect of two surgical techniques for wound closure following ileostomy reversal: gunsight suture (GS) and linear suture (LS). Methods A total of 233 patients who underwent loop ileostomy at the Sixth Affiliated Hospital of Sun Yat-sen University between January 2015 and December 2017 were enrolled into our study. These patients were divided into two groups: the LS group and the GS group. We compared the clinical characteristics between the two groups and analyzed the data using IBM SPSS to identify risk factors for SSI. Results Both groups successfully underwent surgery. The rate of SSI was significantly lower in the GS group (n = 2, 0.02%) than in the LS group (n = 16, 12.00%, P = 0.007). The length of hospital stay after the operation in the GS group was significantly shorter than that in the LS group (8.1 ± 3.2 vs 10.8 ± 5.4 days, P < 0.001). Multivariate analysis showed that GS was an independent protective risk factor for SSI (odds ratio = 0.212, P = 0.048). Conclusions Compared with the LS technique, the GS technique can significantly decrease the rate of SSI and shorten the length of hospital stay after surgery. The GS technique may be recommended for wound closure following ileostomy reversal.
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Affiliation(s)
- Chuang-Kun Li
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Wei-Wen Liang
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Huai-Ming Wang
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Wen-Tai Guo
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Xiu-Sen Qin
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Jie Zhao
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Wen-Bin Zhou
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Yang Li
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Hui Wang
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Rong-Kang Huang
- Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China.,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
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9
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Behuria N, Banerjee JK, Ghosh SR, Kulkarni SV, Saranga Bharathi R. Evidence-based adoption of purse-string skin closure for stoma wounds. Med J Armed Forces India 2020; 76:185-191. [PMID: 32476717 DOI: 10.1016/j.mjafi.2019.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 02/22/2019] [Indexed: 02/05/2023] Open
Abstract
Background Opinion is divided on the optimal technique of skin closure after stoma reversal as most conventional techniques compromise either on speed/neatness of wound apposition or on the incidence of surgical site infection (SSI). Evidence suggests that purse-string skin closure (PSSC) may achieve both objectives. This study aims to compare conventional primary closure (PC) with PSSC to determine the efficacious technique for stoma wound closure. Methods Patients undergoing stoma reversal between April 2015 and September 2017 were prospectively studied. Patients were divided into two groups based on the technique of skin closure (PC or PSSC). The following parameters were assessed: SSI, hospital stay, additional outpatient visit, wound healing time and patient satisfaction based on a standardised questionnaire. Results Forty one patients underwent stoma reversal (20 PSSC vs 21 PC). Wound infection, need for wound care, length of hospital stay, healing time and scar size were significantly less, whereas average patient wound satisfaction scores were significantly more in the PSSC group. Conclusion Purse-string skin closure (PSSC) proves efficacious and hence merits adoption as the technique of choice for closure of stoma wounds.
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Affiliation(s)
- Nilotpal Behuria
- Graded Specialist (Surgery & Gastro-intestinal Surgery), INS Patanjali, Karwar, India
| | - Jayant Kumar Banerjee
- Professor (Gastro-intestinal Surgery), Bharati Vidyapeeth Medical College, Pune, India
| | - Sita Ram Ghosh
- Consultant (Surgery), Command Hospital (Southern Command), Pune 411040, India
| | - Shrirang Vasant Kulkarni
- Classified Specialist ( (Surgery) & Gastro-intestinal Surgeon), Command Hospital (Central Command), Lucknow, India
| | - Ramanathan Saranga Bharathi
- Classified Specialist ( (Surgery) & Gastro-intestinal Surgeon), Command Hospital (Central Command), Lucknow, India
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The Effectiveness of Contralateral Drainage in Reducing Superficial Incisional Surgical Site Infection in Loop Ileostomy Closure: Prospective, Randomized Controlled Trial. World J Surg 2019; 43:1692-1699. [PMID: 30824960 DOI: 10.1007/s00268-019-04972-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Loop ileostomy reduces the rates of morbidity due to colorectal anastomotic dehiscence. For its part, ileostomy closure is associated with low mortality (0-4%) but substantial morbidity (11-37%). Incisional surgical site infection (SSI) is one of the most frequent complications (2-40%). METHODS A single-center, prospective, randomized controlled clinical trial of two study groups: control (conventional primary skin closure) and experimental (primary skin closure with a contralateral Penrose® drain). RESULTS Seventy patients undergoing loop ileostomy closure between April 2013 and June 2017 were included (35 per branch). Four were later removed from the study. Six of the remaining 66 patients (per protocol analysis) were diagnosed with incisional SSI (9.1%); there were no statistically significant differences between the two groups (control group: 9.7%; experimental group: 8.6%) or between the risk factors associated with incisional SSI. Rates of overall and relevant morbidity (Clavien ≥ III) were considerable (28.1% and 9.1%, respectively), and there were no statistically significant differences between the two groups. No patients died. CONCLUSION Contralateral drainage does not significantly affect the results of primary ileostomy closure. The rate of incisional SSI was similar in the drainage and non-drainage groups, and the overall rate of 9.1% was in the low range of those reported in the literature. The absence of mortality (0%) and the non-negligible rates of overall and relevant morbidity (28.1% and 9.1%, respectively) in our series suggest that loop ileostomy is a safe procedure. However, the bowel reconstruction involves risks that must be borne in mind. CLINICAL TRIAL REGISTRATION The study was registered and approved by the clinical research ethics committee of the study center (reference number 2012076). Clinical trial was registered in ClinicalTrial.gov (identification number NCT02574702 and reference: ILEOS-ISS_2013).
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Purse-string vs. linear skin closure at loop ileostomy reversal: a systematic review and meta-analysis. Tech Coloproctol 2019; 23:207-220. [DOI: 10.1007/s10151-019-01952-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/17/2019] [Indexed: 12/18/2022]
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Hajibandeh S, Hajibandeh S, Kennedy-Dalby A, Rehman S, Zadeh RA. Purse-string skin closure versus linear skin closure techniques in stoma closure: a comprehensive meta-analysis with trial sequential analysis of randomised trials. Int J Colorectal Dis 2018; 33:1319-1332. [PMID: 30074070 DOI: 10.1007/s00384-018-3139-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2018] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To compare purse-string skin closure (PSC) and linear skin closure (LSC) techniques in patients undergoing stoma closure METHODS: We conducted a systematic review of literature and meta-analysis of outcomes according to PRISMA statement standards to compare PSC and LSC techniques in stoma closure. Trial sequential analysis (TSA) was performed to assess the possibility of type I or II error and compute the information size required for conclusive meta-analysis. RESULTS We identified six randomised controlled trials (RCTs) and eight observational studies, enrolling a total of 1102 patients. The included populations in the PSC and LSC groups were comparable in terms of baseline characteristics. The risk of surgical site infection (SSI) was significantly lower in the PSC group (OR 0.10; 95% CI 0.06, 0.18; P < 0.00001). There was no difference between the two groups in terms of operative time (MD 1.80; 95% CI - 1.35, 4.96; P = 0.26), anastomotic leak (OR 0.73; 95% CI 0.21, 2.48; P = 0.61), incisional hernia (OR 0.59; 95% CI 0.25, 1.37; P = 0.22), small bowel obstruction (OR 0.96, 95% CI 0.50, 1.86; P = 0.91), and length of hospital stay (MD - 0.04; 95% CI - 0.51, 0.42; P = 0.86). Patient satisfaction was higher in the PSC group. TSA showed that the risk of type 1 error was minimal and meta-analysis was conclusive. CONCLUSIONS PSC is associated with significantly lower risk of SSI and better patient satisfaction compared with LSC in closure of stomas and should be the closure technique of choice. The current available evidence is robust and conclusive highlighting that the results of the current study should be incorporated into clinical practice without a need for further trial data.
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Affiliation(s)
- Shahab Hajibandeh
- Department of General Surgery, Royal Bolton Hospital, Bolton, UK. .,Department of General Surgery, North Manchester General Hospital, Manchester, UK.
| | - Shahin Hajibandeh
- Department of General Surgery, Stepping Hill Hospital, Stockport, UK
| | | | - Sheik Rehman
- Department of General Surgery, Royal Bolton Hospital, Bolton, UK
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Goztok M, Terzi MC, Egeli T, Arslan NC, Canda AE. Does Wound Irrigation with Clorhexidine Gluconate Reduce the Surgical Site Infection Rate in Closure of Temporary Loop Ileostomy? A Prospective Clinical Study. Surg Infect (Larchmt) 2018; 19:634-639. [PMID: 30040537 DOI: 10.1089/sur.2018.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the effect of irrigating the surgical site with 0.05% chlorhexidine gluconate (CHG) on surgical site infection (SSI) in temporary loop ileostomy closure. METHODS In this observational cohort, patients who underwent diverting loop ileostomy and elective ileostomy closure for any reason between September 2014 and July 2016 were enrolled. Irrigation of the surgical site with 0.05% CHG or saline were compared regarding post-operative incision complications. Infection risk was estimated by the National Nosocomial Infection Surveillance System (NNIS) and Study of the Effect of Nosocomial Infection Control (SENIC) scores. Post-operative follow-up was performed by a surgeon blinded to the treatment. Diagnosis of SSI was recorded according to the Guidelines for Prevention of Surgical Site Infection. Wound healing was evaluated by the Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of the deep tissues, Isolation of bacteria, and the duration of inpatient Stay (ASEPSIS) score. RESULTS There were 122 patients meeting the inclusion criteria: 60 in the saline (control) and 62 in the CHG (study) group. The mean age was 56.5 ± 13.5 (standard deviation [SD]); 74 patients were male. The groups were similar regarding age, sex, indication for ileostomy, neoadjuvant therapies, and SENIC and ASEPSIS scores. The overall SSI rate was 18%: 19 patients (31.6%) in the control group and 3 (4.8%) patients in the study group (p < 0.001). The mean ASEPSIS score was higher in the control group (12.8 ± 17.7) than in the study group (3.7 ± 7.8) (p < 0.001). Patients in the control group had significantly higher rates of seroma (13.3% vs 1.6%; p = 0.014) and incision dehiscence (31.6% and 4.8%; p = 0.001). Time to healing was 9.9 ± 5.1 days in the control group and 7.3 ± 5.3 days in the study group (p = 0.007). CONCLUSIONS Irrigation of the incision with 0.05% CHG reduces the SSI rate compared with saline irrigation. There is a need for randomized and wider trials to clarify the effect and standards of incision irrigation.
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Affiliation(s)
- Mustafa Goztok
- 1 Department of General Surgery, Dokuz Eylul University , Izmir, Turkey
| | - Mustafa Cem Terzi
- 2 Department of General Surgery, Bogazici Academy of Clinical Sciences , Istanbul, Turkey
| | - Tufan Egeli
- 1 Department of General Surgery, Dokuz Eylul University , Izmir, Turkey
| | | | - Aras Emre Canda
- 1 Department of General Surgery, Dokuz Eylul University , Izmir, Turkey
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Sureshkumar S, Jubel K, Ali MS, Vijayakumar C, Amaranathan A, Sundaramoorthy S, Palanivel C. Comparing Surgical Site Infection and Scar Cosmesis Between Conventional Linear Skin Closure Versus Purse-string Skin Closure in Stoma Reversal - A Randomized Controlled Trial. Cureus 2018; 10:e2181. [PMID: 29657907 PMCID: PMC5896871 DOI: 10.7759/cureus.2181] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Introduction Stoma closure is one of the most frequently performed surgeries. The common complications are surgical site infection (SSI) and poor scar cosmesis. Purse-string sutures are expected to have less incidence of SSI due to the free drainage of secretions from the wound and possibly the early detection of a wound infection. Compared to the conventional linear closure, the purse-string closure technique is expected to have less wound infection, improved scar cosmesis, and good patient satisfaction because of a smaller size scar. Hence, a well-structured study is required to substantiate the advantage of this technique. Methodology This randomized control trial was carried out for two years in a tertiary care centre in Southern India. Patients with various stoma reversals, including colostomy, as well as ileostomy reversal, were included in the study. Patients were divided into Group I - conventional linear skin suturing (n = 40) and Group II - purse-string closure (n = 40). After the closure of rectus muscle, the skin is closed using the purse-string method (subcuticular) in the experimental group. Results Both the groups were comparable with respect to age, gender, body mass index (BMI), the presence of co-morbidities, and indication for surgery. Stomal procedures were done (26.3%) for malignant cases. The difference in mean hospital days for both groups were statistically insignificant (11.95 vs. 9.9; p = 0.927). The incidence of SSI between the groups were statistically significant (17 vs. 3; p = 0.003). The mean Patient and Observer Scar Assessment Scoring (POSAS) scores between the groups (65.30 vs. 83.40; p = 0.012) were statistically significant. This proved significant improvement in scar cosmesis in purse-string skin closure. At one month postoperative, the purse-string group had better patient satisfaction (3.08 vs. 4.48; p = 0.001), which was evidenced by a mean Likert 3 scale score. The mean visual analogue scale (VAS) score did not show any significant difference in pain between the groups. Conclusion Purse-string skin closure for stoma reversal had significantly less incidence of SSI. The duration of antibiotic therapy was also less in purse-string skin closure patients as compared to linear skin closure patients. Purse-string skin closures significantly improved the scar outcome and patient satisfaction.
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Affiliation(s)
- Sathasivam Sureshkumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Kunnathoor Jubel
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | | | - Chellappa Vijayakumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Anandhi Amaranathan
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sudharsanan Sundaramoorthy
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Chinnakali Palanivel
- Preventive Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Abstract
The umbilicus, a natural orifice, which is used as an access port during laparoscopic surgery, can be used as a stoma site with potential superior cosmetic results as one less incision is then required. Our objective was to assess the efficacy and safety of the umbilical stoma in a selected group of patients. This is a prospective case series in hospital patients admitted as emergency or elective. Patients who underwent laparoscopic colorectal surgery with a planned ileostomy at Box Hill Hospital were approached and invited to participate in the study, with the stoma being fashioned on the umbilicus. Outcomes of interest included demographics, the details regarding the original indication for operation, operative and hospital related outcomes, postoperative bowel related complications, and other surgical and medical complications. Outcomes of a total of 10 (5 males) patients who underwent umbilical covering ileostomy during the study period were analyzed. Two patients with ulcerative colitis had the second stage of their operation converting their end stomas to loop stoma. These were counted twice, totaling 12 stomas in 10 patients. Three patients had their umbistomas after receiving neoadjuvant treatment for rectal cancer. The median period patients have had umbistomas is 113 days. Overall morbidity during the initial operation was low, except for 1 patient who had a small bowel injury. There was no mortality. Minor peristomal skin changes were the most common postoperative complication. Three patients had their stomas reversed with excellent cosmesis. Umbistomas appear to be a safe and effective way to fashion covering stomas post laparoscopic surgery and save the patient an added incision with excellent cosmetic results.
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Alvandipour M, Gharedaghi B, Khodabakhsh H, Karami MY. Purse-String Versus Linear Conventional Skin Wound Closure of an Ileostomy: A Randomized Clinical Trial. Ann Coloproctol 2016; 32:144-9. [PMID: 27626025 PMCID: PMC5019967 DOI: 10.3393/ac.2016.32.4.144] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 07/14/2016] [Indexed: 01/07/2023] Open
Abstract
Purpose Infection is one of the most frequent complications that can occur after ileostomy closure. The incidence of wound infection depends on the skin closure technique, but there is no agreement on the perfect closure method for an ileostomy wound. The aim of this study was to evaluate the incidence of infection, the patient's approval, and the patient's pain between purse-string closure (PSC) and the usual linear closure (LC) of a stoma wound. Methods This randomized clinical trial enrolled 66 patients who underwent a stoma closure from February 2015 to May 2015 in Sari Emam Khomeini Hospital. Patients were divided into 2 groups according to the stoma closing method: the PSC group (n = 34) and the LC group (n = 32). The incidences of infection for the 2 groups were compared, and the patients' satisfaction and pain with the stoma were determined by using a questionnaire. Results Infection occurred in 1 of 34 PSC patients (2.9%) and in 7 of 32 LC patients (21.8%), and this difference was statistically significant (P = 0.021). Patients in the PSC group were more satisfied with the resulting wound scar and its cosmetic appearance at one month and three months after surgery (P = 0.043). Conclusion After stoma closure, PSC was associated with a significantly lower incidence of wound infection and greater patient satisfaction compared to LC. However, the healing period for patients who underwent PSC was longer than it was for those who underwent LC.
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Affiliation(s)
- Mina Alvandipour
- Department of Colorectal Surgery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Babak Gharedaghi
- Department of General Surgery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hamed Khodabakhsh
- Department of Emergency Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Yasin Karami
- Student Research Committee, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Young MT, Hwang GS, Menon G, Feldmann TF, Jafari MD, Jafari F, Perez E, Pigazzi A. Laparoscopic Versus Open Loop Ileostomy Reversal: Is there an Advantage to a Minimally Invasive Approach? World J Surg 2016; 39:2805-11. [PMID: 26272594 DOI: 10.1007/s00268-015-3186-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Ileostomy reversals are commonly performed procedures after colon and rectal operations. Laparoscopic ileostomy reversal (LIR) with lysis of adhesions has potential benefits over conventional open surgery. The aim of this study was to compare outcomes of laparoscopic and open ileostomy reversal. METHODS 133 consecutive patients undergoing ileostomy reversal at our institution between June 2009 and August 2013 were analyzed using a retrospective database. The group comprised 53 laparoscopic cases and 80 open cases, performed by four surgeons at a single center. The data were analyzed for patient demographics, operative characteristics, postoperative outcomes, and 30-day morbidity and mortality. RESULTS The two groups had comparable mean age, gender distribution, ASA scores, and BMI. The laparoscopic group had a significantly longer duration of surgery compared to the open reversal group (109 versus 93 min, p < 0.05). However, this group underwent more lysis of adhesions (60.4 % versus 26.3 %, p < 0.01) as well as concurrent stoma site mesh reinforcement (32.1 % versus 6.3 %, p < 0.01). In the laparoscopy group, 20.7 % of patients underwent intra-corporeal ileo-ileal anastomosis. There were no significant differences between the laparoscopic and open groups with regard to estimated blood loss (31 versus 40 ml, respectively) or mean length of stay (5.3 vs. 5.7 days, respectively). The rates of overall 30-day morbidity (16.9 % for laparoscopic vs. 21.3 % for open) as well as rates of specific complications were equivalent between groups. 30-day mortalities were not noted in either group. CONCLUSION LIR is safe and effective with low perioperative morbidity and mortality. The use of laparoscopy as an option in terms of concomitant hernia repair and lysis of adhesions may be considered in selected patients.
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Affiliation(s)
- Monica T Young
- Department of Surgery, University of California, Irvine School of Medicine, 333 City Blvd West, Suite 850, Orange, CA, 92868, USA
| | - Grace S Hwang
- Department of Surgery, University of California, Irvine School of Medicine, 333 City Blvd West, Suite 850, Orange, CA, 92868, USA. .,Department of Surgery, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA.
| | - Gopal Menon
- Department of Surgery, University of California, Irvine School of Medicine, 333 City Blvd West, Suite 850, Orange, CA, 92868, USA
| | - Timothy F Feldmann
- Department of Surgery, University of California, Irvine School of Medicine, 333 City Blvd West, Suite 850, Orange, CA, 92868, USA
| | - Mehraneh D Jafari
- Department of Surgery, University of California, Irvine School of Medicine, 333 City Blvd West, Suite 850, Orange, CA, 92868, USA
| | - Fariba Jafari
- Department of Surgery, University of California, Irvine School of Medicine, 333 City Blvd West, Suite 850, Orange, CA, 92868, USA
| | - Eden Perez
- Department of Surgery, University of California, Irvine School of Medicine, 333 City Blvd West, Suite 850, Orange, CA, 92868, USA
| | - Alessio Pigazzi
- Department of Surgery, University of California, Irvine School of Medicine, 333 City Blvd West, Suite 850, Orange, CA, 92868, USA.
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Poskus E, Kildusis E, Smolskas E, Ambrazevicius M, Strupas K. Complications after Loop Ileostomy Closure: A Retrospective Analysis of 132 Patients. VISZERALMEDIZIN 2015; 30:276-80. [PMID: 26288601 PMCID: PMC4513804 DOI: 10.1159/000366218] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Closure of a loop ileostomy is a relatively simple procedure although many studies have demonstrated high morbidity rates following it. Methods to reduce the number of complications, such as timing of closure or different surgical closure techniques, are investigated. The aim of this study was to evaluate the experience of the Abdominal Surgery Center at Vilnius University Hospital (VUH) 'Santariskiu klinikos' to review the complications after closure of loop ileostomy and to identify potential risk factors for postoperative complications. METHODS Data from 132 patients who underwent closure of loop ileostomy from 2003 to 2013 at the Abdominal Surgery Center of VUH were collected, including demographics, causes of ileostomy formation, additional diseases, time from creation to closure of ileostomy, anastomotic technique, duration of the operation, postoperative complications, and hospital stay after surgery. The operations were performed by 15 surgeons with varying experience assisted by surgical residents. Experience in ileostomy closure was defined by the number of procedures performed. RESULTS Complications occurred in 24 patients (18.2%), with 20 of them having surgical complications: bowel obstruction (9 (6.8%)), wound infection (4 (3.0%)), peritonitis due to anastomotic leak (3 (2.3%)), intra-abdominal abscess (2 (1.5%)), anastomotic leak with enterocutaneous fistula (1 (0.76%)), and bleeding (1 (0.76%)). 4 patients had non-surgical complications: postoperative diarrhea (2 (1.5%)), urinary retention (1 (0.76%)), and deep vein thrombosis (1 (0.76%)). Most complications were classified as group II according to the Clavien-Dindo classification. 2 patients died (1.5%). The anastomotic technique used did not affect the outcome. The experience of the surgeon as judged by the frequency of the procedure was the main factor affecting postoperative morbidity significantly (p = 0.03). CONCLUSION Our study revealed that the rate of postoperative complications and a smooth postoperative course after the closure of ileostomy was influenced by surgical experience.
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Affiliation(s)
- Eligijus Poskus
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania ; Center of Abdominal Surgery, Vilnius University Hospital 'Santariskiu Klinikos', Vilnius University, Vilnius, Lithuania
| | - Edvinas Kildusis
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania ; Center of Abdominal Surgery, Vilnius University Hospital 'Santariskiu Klinikos', Vilnius University, Vilnius, Lithuania
| | | | - Marijus Ambrazevicius
- Center of Abdominal Surgery, Vilnius University Hospital 'Santariskiu Klinikos', Vilnius University, Vilnius, Lithuania
| | - Kestutis Strupas
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania ; Center of Abdominal Surgery, Vilnius University Hospital 'Santariskiu Klinikos', Vilnius University, Vilnius, Lithuania
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Pan HD, Wang L, Peng YF, Li M, Yao YF, Zhao J, Zhan TC, Du CZ, Gu J. Subcutaneous vacuum drains reduce surgical site infection after primary closure of defunctioning ileostomy. Int J Colorectal Dis 2015; 30:977-82. [PMID: 25700809 DOI: 10.1007/s00384-015-2168-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE Surgical site infection (SSI) is the most common complication after primary closure of defunctioning ileostomy. We use a subcutaneous vacuum drain (SVD) in our institution to prevent infection. This study aimed to analyze the risk factors of SSI and to assess the utility of an SVD for preventing SSI in patients undergoing primary closure of ileostomy. METHODS Patients undergoing ileostomy closure in the Department of Colorectal Surgery, Peking University Cancer Hospital, from September 2006 to March 2013, were included in this study. The clinical features of these patients with or without a subcutaneous drain were reviewed, and the complication rate of SSI was analyzed. The primary endpoints were the incidence and risk factors of SSI, and the secondary endpoints were the rate of overall complications and their management. RESULTS A total of 245 consecutive patients were enrolled in the study. The overall incidence of SSI was 8.6%. Eighty-five (34.7%) patients received placement of an SVD. The use of SVDs was associated with a significantly lower incidence of SSI compared with primary closure (PC) without an SVD (1.2 vs. 12.5%, p = 0.001). Multivariate analyses showed that the presence of an SVD (odds ratio (OR) 0.063, p = 0.012), total operation time >90 min (OR 4.862, p = 0.002), and postoperative complications (OR 10.576, p < 0.001) were independent risk factors of SSI. CONCLUSIONS This study shows that an SVD is effective for reducing SSI in patients undergoing PC of ileostomy. Further randomized trials are required to confirm our findings and to compare SVDs with purse-string sutures.
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Affiliation(s)
- Hong-Da Pan
- Department of Colorectal Surgery, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing Cancer Hospital, Fucheng Road 52, Haidian District, 100142, Beijing, China
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Yoon SI, Bae SM, Namgung H, Park DG. Clinical trial on the incidence of wound infection and patient satisfaction after stoma closure: comparison of two skin closure techniques. Ann Coloproctol 2015; 31:29-33. [PMID: 25745624 PMCID: PMC4349913 DOI: 10.3393/ac.2015.31.1.29] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 01/20/2015] [Indexed: 10/26/2022] Open
Abstract
PURPOSE Surgical site infection (SSI) is one of the most common complications that can occur after stoma closure. Reports have described differences in the incidence of wound infection depending on the skin closure technique, but there is no consensus on the ideal closure technique for a stoma wound. The aim of this study was to compare the incidence of SSI and the patient satisfaction between a circumferential purse-string approximation (CPA) and a primary linear closure (PC) of a stoma wound. METHODS This prospective nonrandomized trial enrolled 48 patients who underwent a stoma closure from February 2010 to October 2013. Patients were divided into two groups according to the stoma closing technique: the CPA group (n = 34) and the PC group (n = 14). The incidences of SSI for the two groups were compared, and the patients' satisfaction with the stoma closure was determined by using a questionnaire. RESULTS SSI occurred in 3 of 48 patients (6.3%) and was more frequent in the PC group than in the CPA group (3/14 [21.4%] vs. 0/34 [0%], P = 0.021). Time to complete healing after stoma closure in the CPA group was 32 days (range, 14-61 days). Patients in the CPA group were more satisfied with the resulting wound scar (P = 0.043). CONCLUSION After stoma closure, CPA was associated with a significantly lower incidence of wound infection and greater patient satisfaction compared to PC. However, with the CPA technique, the time to heal is longer than it is with PC.
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Affiliation(s)
- Sang Il Yoon
- Department of Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Sun Mi Bae
- Department of Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Hwan Namgung
- Department of Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Dong Guk Park
- Department of Surgery, Dankook University College of Medicine, Cheonan, Korea
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Wada Y, Miyoshi N, Ohue M, Noura S, Fujino S, Sugimura K, Akita H, Motoori M, Gotoh K, Takahashi H, Kobayashi S, Ohmori T, Fujiwara Y, Yano M. Comparison of surgical techniques for stoma closure: A retrospective study of purse-string skin closure versus conventional skin closure following ileostomy and colostomy reversal. Mol Clin Oncol 2015; 3:619-622. [PMID: 26137277 DOI: 10.3892/mco.2015.505] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/08/2015] [Indexed: 12/17/2022] Open
Abstract
The aim of this study was to compare the incidence of postoperative complications, including superficial incisional surgical site infection (SSI) following purse-string skin closure (PS) and conventional skin closure with a drainage tube (CD) following stoma closure. A total of 55 consecutive patients who underwent loop colostomy and loop ileostomy closures in our hospital between October, 2011 and September, 2014 were retrospectively assessed. The patients were divided into two groups, namely the PS group (26 patients) and the CD group (29 patients). There were no significant differences in the characteristics of the patients between the two groups. The baseline and operative characteristics also did not differ significantly between the two groups. However the incidence of superficial incisional SSI was lower in the PS group compared to that in the CD group (0 vs. 13.8%, respectively; P=0.049). The overall incidence of complications did not differ significantly between the two groups (P=0.313). The duration of postoperative hospital stay in the PS group was shorter compared to that in the CD group. In conclusion, the results of this study suggest that PS may an effective technique to reduce the incidence of superficial incisional SSI. This technique appears to be superior to the conventional technique, allowing for better cosmesis.
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Affiliation(s)
- Yuma Wada
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Norikatsu Miyoshi
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Masayuki Ohue
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Shingo Noura
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Shiki Fujino
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Keijirou Sugimura
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Hirofumi Akita
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Masaaki Motoori
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Kunihito Gotoh
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Hidenori Takahashi
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Shogo Kobayashi
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Takeshi Ohmori
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Yoshiyuki Fujiwara
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
| | - Masahiko Yano
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka 537-8511, Japan
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22
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Lee JT, Marquez TT, Clerc D, Gie O, Demartines N, Madoff RD, Rothenberger DA, Christoforidis D. Pursestring closure of the stoma site leads to fewer wound infections: results from a multicenter randomized controlled trial. Dis Colon Rectum 2014; 57:1282-9. [PMID: 25285695 DOI: 10.1097/dcr.0000000000000209] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Surgical site infection after stoma reversal is common. The optimal skin closure technique after stoma reversal has been widely debated in the literature. OBJECTIVE We hypothesized that pursestring near-complete closure of the stoma site would lead to fewer surgical site infections compared with conventional primary closure. DESIGN This study was a parallel prospective multicenter randomized controlled trial. SETTINGS This study was conducted at 2 university medical centers. PATIENTS Patients (N = 122) presenting for elective colostomy or ileostomy reversal were selected. INTERVENTIONS Pursestring versus conventional primary closure of stoma sites were compared. MAIN OUTCOME MEASURES Stoma site surgical site infection within 30 days of surgery, overall surgical site infection, delayed healing (open wound for >30 days), time to wound epithelialization, and patient satisfaction were the primary outcomes measured. RESULTS The pursestring group had a significantly lower stoma site infection rate (2% vs 15%, p = 0.01). There was no difference in delayed healing or patient satisfaction between groups. Time to epithelialization was measured in only 51 patients but was significantly longer in the pursestring group (34.6 ± 20 days vs 24.1 ± 17 days, p = 0.02). LIMITATIONS This study was limited by the variability in procedures and surgeons, the limited follow-up after 30 days, and the inability to perform blinding. CONCLUSION Pursestring closure after stoma reversal has a lower risk of stoma site surgical site infection than conventional primary closure, although wounds may take longer to heal with the use of this approach. REGISTRATION NUMBER NCT01713452 (www.clinicaltrials.gov).
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Affiliation(s)
- Janet T Lee
- 1Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota 2Department of Surgery, Mercy Clinic, Saint Louis, Missouri 3Division of Visceral Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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23
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Habbe N, Hannes S, Liese J, Woeste G, Bechstein WO, Strey C. The use of purse-string skin closure in loop ileostomy reversals leads to lower wound infection rates--a single high-volume centre experience. Int J Colorectal Dis 2014; 29:709-14. [PMID: 24407267 DOI: 10.1007/s00384-013-1822-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/31/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE Wound infections affect not only the individual patient but lead to an increase in medical costs. After ileostomy reversal, surgical site infections are a common problem. The objective of the study was to compare the infection rates of purse-string and conventional skin closure techniques in a high volume setting. METHODS Patients undergoing ileostomy reversal at the Goethe University Hospital between January 2009 and August 2012 were retrospectively analysed regarding surgical site infections and associated risk factors. Patients received either conventional skin closure (running, interrupted or stapled suturing; group C) or subcuticular purse-string suture (group PS). RESULTS In total, 114 patients have been analysed. Conventional wound closure was performed in 81 patients and 33 patients received purse-string skin closure. The groups did not differ regarding age, gender, indication for ileostomy, previous chemotherapy, and operation time. Median hospital stay was 7 days (3-34) in group PS and 8 (3-53) in group C (p = 0.15). Wound infections only occurred in groups C (n = 10, 12 %) compared to group PS (n = 0; 0 %; p = 0.034), and the wound closure technique was the only significant factor associated with surgical site infection. Surgery performed by a resident under supervision was not a risk factor for complications compared to the procedure done by a senior surgeon (p = 0.73). CONCLUSION This study reveals an advantage of the purse-string skin closure technique in ileostomy reversals analysing a large cohort of patients. Therefore, we recommend the use of the purse-string skin closure in ileostomy reversals as one way to lower wound infection rates.
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Affiliation(s)
- Nils Habbe
- Department of General and Visceral Surgery, Hospital of the Johann Wolfgang Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany,
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24
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Suh YJ, Park JW, Kim YS, Park SC, Oh JH. A beneficial effect of purse-string skin closure after ileostomy takedown: a retrospective cohort study. Int J Surg 2014; 12:615-20. [PMID: 24810869 DOI: 10.1016/j.ijsu.2014.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 03/28/2014] [Accepted: 04/25/2014] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the clinical benefits of purse-string skin closure (PS) in daily practice compared with conventional linear skin closure (CL) after ileostomy takedown in Korean population. METHODS These retrospectively collected data were based on 157 consecutive patients who underwent ileostomy takedown between November 2010 and September 2011. Before March, 2011, CL was performed in 79 patients. Thereafter, PS was performed in 78 patients. The medical records including pain score recorded daily were reviewed and the postoperative outcomes, including SSI, were analyzed. RESULTS PS group had a significantly lower overall complication rate than the CL group (8.97% vs. 25.32%, p = 0.010). Among complications, PS group had a significantly lower SSI rate than the CL group (0% vs. 11.39%, p = 0.003). After adjusted for other risk factors (smoking, body mass index, anastomosis method), PS method was associated significantly and independently with a lower SSI rate than CL method (adjusted odds ratio: 26.63, 95% confidence interval: 3.02-267.70, p = 0.001). And the two groups did not differ in terms of postoperative pain (p = 0.323) or pain pattern (p = 0.548). CONCLUSION In daily practice, PS had a beneficial effect on SSI in patients who underwent ileostomy takedown in the Korean population.
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Affiliation(s)
- Yong Joon Suh
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea
| | - Ji Won Park
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Republic of Korea.
| | - Yong Sok Kim
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Republic of Korea
| | - Sung Chan Park
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Republic of Korea
| | - Jae Hwan Oh
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Republic of Korea
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25
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López-Cano M, Pereira JA, Villanueva B, Vallribera F, Espin E, Armengol Carrasco M, Arbós Vía MA, Feliu X, Morales-Conde S. Abdominal wall closure after a stomal reversal procedure. Cir Esp 2014; 92:387-92. [PMID: 24581880 DOI: 10.1016/j.ciresp.2014.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 12/06/2013] [Accepted: 01/09/2014] [Indexed: 12/17/2022]
Abstract
The closure of a temporary stoma involves 2 different surgical procedures: the stoma reversal procedure and the abdominal wall reconstruction of the stoma site. The management of the abdominal wall has different areas that should be analyzed such us how to avoid surgical site infection (SSI), the technique to be used in case of a concomitant hernia at the stoma site or to prevent an incisional hernia in the future, how to deal with the incision when the stoma reversal procedure is performed by laparoscopy and how to close the skin at the stoma site. The aim of this paper is to analyze these aspects in relation to abdominal wall reconstruction during a stoma reversal procedure.
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Affiliation(s)
- Manuel López-Cano
- Cirugía de la Pared Abdominal, Servicio de Cirugía General y Digestiva, Hospital Universitario Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, España; Grupo de Investigación de Cirugía General y Digestiva, Pared Abdominal, Biomateriales, Institut de Recerca Vall d'Hebrón (IRVH), Edificio Collserola; Lab 211A, Barcelona, España.
| | - José Antonio Pereira
- Departament de Ciéncies Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, España
| | - Borja Villanueva
- Cirugía de la Pared Abdominal, Servicio de Cirugía General y Digestiva, Hospital Universitario Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, España
| | - Francesc Vallribera
- Cirugía Colorrectal, Servicio de Cirugía General y Digestiva, Hospital Universitario Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, España
| | - Eloy Espin
- Cirugía Colorrectal, Servicio de Cirugía General y Digestiva, Hospital Universitario Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, España
| | - Manuel Armengol Carrasco
- Cirugía de la Pared Abdominal, Servicio de Cirugía General y Digestiva, Hospital Universitario Vall d'Hebrón, Universitat Autònoma de Barcelona, Barcelona, España; Grupo de Investigación de Cirugía General y Digestiva, Pared Abdominal, Biomateriales, Institut de Recerca Vall d'Hebrón (IRVH), Edificio Collserola; Lab 211A, Barcelona, España
| | - María Antonia Arbós Vía
- Grupo de Investigación de Cirugía General y Digestiva, Pared Abdominal, Biomateriales, Institut de Recerca Vall d'Hebrón (IRVH), Edificio Collserola; Lab 211A, Barcelona, España
| | - Xavier Feliu
- Servicio de Cirugía General, Hospital General d'Igualada, Igualada, Barcelona, España
| | - Salvador Morales-Conde
- Unidad de Innovación en Cirugía Mínimamente Invasiva, Hospital Universitario Virgen del Rocío, Sevilla, España
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26
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Klink CD, Wünschmann M, Binnebösel M, Alizai HP, Lambertz A, Boehm G, Neumann UP, Krones CJ. Influence of skin closure technique on surgical site infection after loop ileostomy reversal: retrospective cohort study. Int J Surg 2013; 11:1123-5. [PMID: 24035923 DOI: 10.1016/j.ijsu.2013.09.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 08/28/2013] [Accepted: 09/02/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Intestinal stoma closure is associated with high risk of surgical site infection (SSI) at stoma reversal site. The aim of this retrospective cohort study was to determine the outcome of purse string approximation (PSA) compared to primary linear closure (PLC) of the skin after loop ileostomy reversal. METHODS Data of 140 patients operated between 2005 and 2012 were analyzed in this two-center-study to determine the outcome of patients with either PSA (n = 44) or PLC (n = 96) after loop ileostomy reversal. RESULTS Patients in the PSA group were significantly older than in the PLC group (64 ± 15 vs. 57 ± 18; p = 0.026). Cardiac diseases were significantly more present in the PSA group in comparison to the PLC group (59% vs. 38%; p = 0.017). Stoma creation was significantly more often due to malignancy in the PSA group in comparison to the PLC group (68% vs. 50%; p = 0.044). SSI occurred significantly more often in the PLC group in comparison to the PSA group (17% vs. 5%; p = 0.047). CONCLUSIONS The risk for SSI is lower in patients with PSA in comparison to patients with PLC. In order to diminish SSI we recommend performing a PSA in patients with loop ileostomy reversal.
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Affiliation(s)
- C D Klink
- Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Germany.
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27
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Dusch N, Goranova D, Herrle F, Niedergethmann M, Kienle P. Randomized controlled trial: comparison of two surgical techniques for closing the wound following ileostomy closure: purse string vs direct suture. Colorectal Dis 2013; 15:1033-40. [PMID: 23634717 DOI: 10.1111/codi.12211] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 11/04/2012] [Indexed: 02/08/2023]
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 techniques - direct suture (DS) and purse-string suture (PSS) - used to close the wound following ileostomy closure. The primary end-point was the SSI rate. Secondary end-points 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. CONCLUSION The 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.
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Affiliation(s)
- N Dusch
- Department of Surgery, University of Heidelberg, Mannheim, Germany
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28
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McCartan DP, Burke JP, Walsh SR, Coffey JC. Purse-string approximation is superior to primary skin closure following stoma reversal: a systematic review and meta-analysis. Tech Coloproctol 2013; 17:345-51. [DOI: 10.1007/s10151-012-0970-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 12/27/2012] [Indexed: 12/20/2022]
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