Pursestring closure of the stoma site leads to fewer wound infections: Results from a multicenter randomized controlled trial

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.