TY - JOUR
T1 - Pursestring closure of the stoma site leads to fewer wound infections
T2 - Results from a multicenter randomized controlled trial
AU - Lee, Janet T.
AU - Marquez, Thao T.
AU - Clerc, Daniel
AU - Gie, Olivier
AU - Demartines, Nicolas
AU - Madoff, Robert D.
AU - Rothenberger, David A.
AU - Christoforidis, Dimitrios
PY - 2014/1/1
Y1 - 2014/1/1
N2 - 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 nearcomplete 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.
AB - 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 nearcomplete 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.
KW - Ostomy reversal
KW - Pursestring closure
KW - Stoma complications
KW - Surgical site infection
UR - http://www.scopus.com/inward/record.url?scp=84921719210&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84921719210&partnerID=8YFLogxK
U2 - 10.1097/DCR.0000000000000209
DO - 10.1097/DCR.0000000000000209
M3 - Article
C2 - 25285695
AN - SCOPUS:84921719210
VL - 57
SP - 1282
EP - 1289
JO - Diseases of the Colon and Rectum
JF - Diseases of the Colon and Rectum
SN - 0012-3706
IS - 11
ER -