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Zhang XQ, Tang RX, Pan DH, Zhang CF, Xia MY, Shuai LY, Tang H, Ji GY. Laparoscopic versus open ileostomy closure: a systematic review and meta-analysis of postoperative outcomes. Int J Colorectal Dis 2025; 40:109. [PMID: 40323516 PMCID: PMC12053327 DOI: 10.1007/s00384-025-04897-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2025] [Indexed: 05/08/2025]
Abstract
PURPOSE This study aims to compare laparoscopic versus open in ileostomy reversal techniques from multiple perspectives and to gain insight into the potential advantages and limitations of laparoscopic techniques and provide guidance on finding the best anastomosis for ileostomy reversal. METHODS This systematic review and meta-analysis has been pre-registered with PROSPERO. The registration number is CRD42025640754. A rigorous literature search was conducted across multiple databases, including Embase, PubMed, Cochrane Library, and China National Knowledge Infrastructure. The primary outcome measure was the incidence of overall postoperative complications, and the secondary outcomes included operative time, estimated blood loss, and the length hospital stay. RESULTS This research included 11 studies with a total of 867 cases, showing that the laparoscopic surgery group had a significantly lower overall complication rate compared to the open surgery group (OR = 0.40, 95% CI: 0.27-0.59, P < 0.00001). Further investigation of specific postoperative complications revealed that laparoscopic surgery significantly reduced the risk of bowel obstruction (OR = 0.39, 95% CI: 0.18-0.83, P = 0.01) and wound infection (OR = 0.41, 95% CI: 0.23-0.73, P = 0.003), with no significant difference observed for anastomotic leaks (OR = 0.40, 95% CI: 0.11-1.43, P = 0.16). Although laparoscopic surgery required a longer operative time (P = 0.002), it resulted in significantly shorter hospital stays (P < 0.00001) and did not increase estimated blood loss (P = 0.50). In addition, both extracorporeal laparoscopic surgery and intracorporeal laparoscopic surgery can effectively reduce the occurrence of postoperative complications and shorten the length of hospital stay compared with open surgery. CONCLUSION Laparoscopic-assisted ileostomy closure (both intracorporeal and extracorporeal techniques) demonstrates significant clinical benefits, including reduced postoperative complication rates, shortened hospitalization duration, and optimized recovery trajectories.
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Affiliation(s)
- Xiao-Qiang Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang District, Chongqing, 400016, China
| | - Run-Xi Tang
- Shanxi Provincial Institute of Traditional Chinese Medicine, Taiyuan, 030021, Shanxi, China
| | - Dong-Hao Pan
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang District, Chongqing, 400016, China
| | - Chao-Fu Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang District, Chongqing, 400016, China
| | - Ming-Yang Xia
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang District, Chongqing, 400016, China
| | - Lei-Yuan Shuai
- Department of Anorectal Surgery, Jiangjin Central Hospital of Chongqing, Chongqing, 404000, China
| | - Hua Tang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang District, Chongqing, 400016, China
| | - Guang-Yan Ji
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang District, Chongqing, 400016, China.
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Ameer A, Mirza MB, Talat N. The Outcome of Purse-string Versus Conventional Wound Closure Techniques in Patients Undergoing Stoma Reversal: A Randomized Controlled Trial. J Pediatr Surg 2024; 59:1186-1189. [PMID: 37978002 DOI: 10.1016/j.jpedsurg.2023.10.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/14/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Patients undergoing stoma reversal may experience surgical site infections and poor scarring. A purse-string closure approach may lower the incidence of surgical site infections due to its inherent ability to drain wound exudates. This study compared the frequency of surgical site infections and the cosmetic outlook of the scar among patients undergoing stoma reversal with linear and purse-string skin closure techniques. SETTING AND DURATION Department of Pediatric Surgery, University of Child Health Sciences Lahore with a duration of one year (June 2021 to June 2022). METHODS This randomized controlled trial (TCTR20210417001) was conducted with IRB approval. A total of 124 patients undergoing stoma reversal were randomly assigned to two groups (62 in each): Group A received conventional linear skin closure, while Group B received purse-string wound closure. The study evaluated surgical site infection, cosmetic outcome, and length of stay. RESULTS Both groups had similar age, gender ratio, indication for surgery, and length of stay. The purse-string group had a significantly lower incidence of SSI (38.7 % vs. 14.5 %; p = 0.002) and better scar quality (Manchester scar scale showed 'good' scar quality in 63 % of patients vs. 22.6 % in the linear closure group, p-value <0.0001). CONCLUSION The purse-string technique for skin closure resulted in fewer surgical site infections and improved scar appearance.
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Affiliation(s)
- Assad Ameer
- Department of Pediatric Surgery, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan
| | - Muhammad Bilal Mirza
- Department of Pediatric Surgery, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan.
| | - Nabila Talat
- Department of Pediatric Surgery, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan
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Borejsza-Wysocki M, Szmyt K, Jeske P, Bobkiewicz A, Ledwosiński W, Banasiewicz T, Krokowicz Ł. Analysis of risk factors for surgical site infection and other postoperative complications in patients following loop ileostomy reversal. POLISH JOURNAL OF SURGERY 2024; 96:44-49. [PMID: 39138989 DOI: 10.5604/01.3001.0054.4604] [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: 08/15/2024]
Abstract
<b>Introduction:</b> Loop ileostomy reversal (LIR) procedure is still associated with a relatively high risk of complications. Surgical site infection (SSI) is the most common complication in this group of patients. SSI leads to prolonged hospital stays, delays the adjuvant therapy, and increases hospital costs.<b>Aim:</b> The aim of the study was to analyze the risk factors for SSI in patients following loop ileostomy reversal procedure.<b>Material and methods:</b> A single-center retrospective analysis was conducted in a tertiary reference center. Finally, 65 patients following loop ileostomy reversal procedure performed between 2018 and 2022 were enrolled in the study. Data were collected retrospectively based on the available medical charts. The study group comprised 23 women (35%) and 42 men (65%) with a mean age of 48.9 14.5 years and a mean body mass index of 24.3 4.9 kg/m<sup>2</sup> . The most common indication for index surgery was ulcerative colitis (33%) and colorectal cancer (29%). Preferably, handsewn anastomosis was performed (n = 42; 64.6%).<b>Results:</b> The most important parameter evaluated in the above study was the diagnosis of surgical site infection, which influenced e.g. hospitalization after surgery, the need for antibiotic therapy, or C-reactive protein (CRP) values. Nine patients (13.8%) were diagnosed with SSI during their hospital stay (more than 86% without SSI). In the group with SSI, hospital stay exceeded 13 days compared to almost 6 days in the group without SSI (P = 0.00009). The time of the procedure had a statistically significant correlation with antibiotic therapy introduction (P = 0.01). The type of intestinal anastomosis had a significant impact on the operative time (P = 0.0011) and the time of hospital stay after surgery (P = 0.04).<b>Conclusions:</b> Most of the analyzed clinical factors were directly related to the impact on the duration of postoperative hospitalization. The duration of hospitalization is an independent and undeniable factor increasing the risk of other postoperative complications and significantly increasing the cost of hospitalization. Another factor that has a large clinical impact on postoperative treatment is the presence of comorbidities which make patients more likely to develop SSI, CRP increase, or the need for antibiotic therapy. An important factor was the level of CRP, the elevated value of which may be a predictor of many negative aspects in postoperative treatment.
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Affiliation(s)
- Maciej Borejsza-Wysocki
- Department of General, Endocrine and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poland
| | - Krzysztof Szmyt
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poland
| | - Pamela Jeske
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poland
| | - Adam Bobkiewicz
- Department of General, Endocrine and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poland
| | - Witold Ledwosiński
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poland
| | - Tomasz Banasiewicz
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poland
| | - Łukasz Krokowicz
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poland
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Kang SI, Kim S. The effectiveness of negative-pressure wound therapy for wound healing after stoma reversal: a randomized control study. Ann Surg Treat Res 2023; 105:126-132. [PMID: 37693285 PMCID: PMC10485349 DOI: 10.4174/astr.2023.105.3.126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/06/2023] [Accepted: 08/06/2023] [Indexed: 09/12/2023] Open
Abstract
Purpose The purse-string closure (PSC) method is used for skin closure after stoma reversal to reduce surgical site infections (SSIs). However, PSC requires a longer healing period than primary closure. The application of negative-pressure wound therapy (NPWT) may reduce the healing period of many wound types. This study aimed to investigate whether the application of NPWT promotes wound healing after the PSC method for stoma reversal. Methods This study was a randomized controlled study. Patients who had undergone stoma reversal surgery were randomized to receive NPWT or simple dressing after surgery. The primary outcome was a complete wound-healing period. We also investigated SSI, hospital stay, total cost, and the patient and observer scar assessment scale (POSAS) as secondary outcomes. Results A total of 36 patients were randomized into 2 groups. The median wound healing period was shorter in the NPWT group than in the control group (17.5 days [range, 11-24 days] vs. 21.5 days [range, 14-41 days], P = 0.006). SSI rate and hospital stay did not differ between the groups. However, the number of dressings was lower in the NPWT group than in the control group (5 [range, 3-7] vs. 17 [range, 10-30], P < 0.001). The total cost for dressing was comparable between the groups. The POSAS was not different between the groups. Conclusion This study revealed that NPWT application after PSC for stoma reversal site is effective in reducing the wound healing period compared to simple dressing, without increasing SSI and total cost.
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Affiliation(s)
- Sung Il Kang
- Department of Surgery, Yeungnam University Medical Center, Yeungnam Uiversity College of Medicine, Daegu, Korea
| | - Sohyun Kim
- Department of Surgery, Yeungnam University Medical Center, Yeungnam Uiversity College of Medicine, Daegu, Korea
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von Savigny C, Juratli MA, Koch C, Gruber-Rouh T, Bechstein WO, Schreckenbach T. Short-term outcome of diverting loop ileostomy reversals performed by residents: a retrospective cohort prognostic factor study. Int J Colorectal Dis 2023; 38:108. [PMID: 37084093 PMCID: PMC10121496 DOI: 10.1007/s00384-023-04390-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 04/22/2023]
Abstract
AIM The reversal of diverting loop ileostomy (DLI) is one of surgical trainees' first procedures. Complications of DLI reversal can cause life-threatening complications and increase patient morbidity. This study compared DLI reversals performed by surgical trainees with those by attending surgeons. METHOD This retrospective cohort study was performed at a single primary care center on 300 patients undergoing DLI reversal. The primary outcome was morbidity, according to the Clavien-Dindo classification (CDC), with special attention paid to the surgeon's level of training. The secondary endpoint was postoperative intestinal motility dysfunction. RESULTS Surgical trainees had significantly longer operation times (p < 0.001) than attending surgeons. Univariate analyses revealed no influence on the level of training for postoperative morbidity. First bowel movement later than 3 days after surgery was a significant risk factor for CDC [Formula: see text] 3 (OR, 4.348; 96% CI, 1670-11.321; p = 0.003). Independent risk factors for surgical site infections (SSIs) were an elevated BMI (OR, 1.162; 95% CI, 1.043-1.1294; p = 0.007) and a delayed bowel movement (OR, 3.973; 95% CI, 1.300-12.138; p = 0.015). For postoperative intestinal motility dysfunction, an independent risk factor was a primary malignant disease (OR, 1.980; 95% CI, 1.120-3.500; p = 0.019), and side-to-side stapled anastomosis was a protective factor (OR, 0.337; 95% CI 0.155-0.733; p = 0.006). CONCLUSION Even though surgical trainees needed significantly more time to perform the surgery, the level of surgical training was not a risk factor for increased postoperative morbidity. Instead, delayed first bowel movement was predictive of SSI.
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Affiliation(s)
- Clara von Savigny
- Department of General, Visceral, Transplantation, and Thoracic Surgery, Goethe University Frankfurt/Main, Frankfurt University Hospital and Clinics, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Mazen A Juratli
- Department of General, Visceral and Transplant Surgery, Muenster University Hospital, Muenster, Germany
| | - Christine Koch
- Department of Internal Medicine, Goethe University Frankfurt/Main, Frankfurt University Hospital and Clinics, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Tatjana Gruber-Rouh
- Institute of Diagnostical and Interventional Radiology, Goethe University Frankfurt/Main, Frankfurt University Hospital and Clinics, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Wolf O Bechstein
- Department of General, Visceral, Transplantation, and Thoracic Surgery, Goethe University Frankfurt/Main, Frankfurt University Hospital and Clinics, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany
| | - Teresa Schreckenbach
- Department of General, Visceral, Transplantation, and Thoracic Surgery, Goethe University Frankfurt/Main, Frankfurt University Hospital and Clinics, Theodor-Stern-Kai 7, 60596, Frankfurt/Main, Germany.
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Kojima K, Goto M, Nagashima Y, Saito Y, Kawai M, Takebe S, Egawa A, Tanba M, Ishikawa K, Matsuoka H, Masaki T, Sunami E, Ohura N, Teruya K, Eto K, Nozawa K, Sakamoto K, Funahashi K. Effectiveness of negative pressure wound therapy for the wound of ileostomy closure: a multicenter, phase II randomized controlled trial. BMC Surg 2021; 21:442. [PMID: 34963451 PMCID: PMC8713411 DOI: 10.1186/s12893-021-01446-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 12/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The American Society of Surgery and American Society for Surgical Infections issued guidelines for surgical site infections (SSIs) in December 2016. These guidelines recommend a purse-string suture (PSS) for stoma closure as it facilitates granulation and enables open wound drainage. This study investigated the effect of using negative pressure wound therapy (NPWT) along with standard PSS and aimed to determine the optimal period of NPWT use. METHODS The patients were divided into three groups as follows: Group A, postoperative wound management alone with gauze exchange as the representative of conventional PSS; Group B, the performed management was similar to that of Group A plus NPWT for 1 week; and Group C, the performed management was similar to that of Group A plus NPWT for 2 weeks. Regarding objective measures, the wound reduction rate was the primary outcome, and the incidence of SSIs, length of hospital stay, and wound healing duration were the secondary outcomes. RESULTS In total, 30 patients (male: 18, female: 12) were enrolled. The average age was 63 (range: 43-84) years. The wound reduction rate was significantly higher in Group B than in Group A on postoperative days (PODs) 7 (66.1 vs. 48.4%, p = 0.049) and 10 (78.6 vs. 58.2%, p = 0.011), whereas no significant difference was observed on POD 14. Compared with Group A, Group C (POD 7: 65.9%, POD 10: 69.2%) showed an increase in the wound reduction rate on POD 7, although the difference was not significant (p = 0.075). SSIs were observed in Groups B (n = 2) and C (n = 2) (20%) but not in Group A (0%). CONCLUSIONS The most effective duration of NPWT use for ileostomy closure with PSS in terms of the maximum wound reduction rate was from PODs 3 to 10. However, NPWT did not shorten the wound healing duration. NPWT may reduce the wound size but should be used with precautions for SSIs. The small sample size (30 cases), the use of only one type of NPWT system, and the fact that wound assessment was subjective and not blinded were the limitations of this study. Further studies are needed to confirm our findings. TRIAL REGISTRATION UMIN Clinical Trials Registry; UMIN000032174 (10/04/2018).
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Affiliation(s)
- Koichiro Kojima
- Department of Surgery, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka city, Tokyo, 181-8611, Japan.
| | - Mayu Goto
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Yasuo Nagashima
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Yoko Saito
- WOCN, Department of Nursing, Toho University Omori Medical Center, Tokyo, Japan
| | - Masaya Kawai
- Department of Coloproctological Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Shihori Takebe
- WOCN, Department of Nursing, Juntendo University School of Medicine, Tokyo, Japan
| | - Akiko Egawa
- WOCN, Department of Nursing, The Jikei University School of Medicine, Tokyo, Japan
| | - Mitsuko Tanba
- WOCN, Department of Nursing, Kyorin University School of Medicine, Tokyo, Japan
| | - Kazue Ishikawa
- WOCN, Department of Nursing, Teikyo University School of Medicine, Tokyo, Japan
| | - Hiroyoshi Matsuoka
- Department of Paramedics, Kyorin University Faculty of Health Sciences, Tokyo, Japan
| | - Tadahiko Masaki
- Department of Surgery, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka city, Tokyo, 181-8611, Japan
| | - Eiji Sunami
- Department of Surgery, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka city, Tokyo, 181-8611, Japan
| | - Norihiko Ohura
- Department of Plastic, Reconstructive and Aesthetic Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Koji Teruya
- Department of Health & Welfare, Kyorin University Faculty of Health Sciences, Tokyo, Japan
| | - Ken Eto
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Keijiro Nozawa
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Kazuhiro Sakamoto
- Department of Coloproctological Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kimihiko Funahashi
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
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Abstract
Zusammenfassung
Einleitung
Bei einer 69-jährigen Patientin kam es nach Umwandlung eines doppelläufigen in ein endständiges Kolostoma zu einer Wundheilungsstörung, welche aufgrund der Nähe zum Stoma schwer zu behandeln war. Wir entwickelten eine getunnelte subkutane endoskopische Unterdrucktherapie, um die Wunde verschlossen zu halten, sodass eine uneingeschränkte Funktion des Stomas möglich blieb.
Methode
Es wurden drei verschiedene offenporige Schlauchdrainagen verwendet. An das distale Ende einer Magensonde wurde entweder ein offenporiger PU-Schwamm (OPD), eine dünne, doppellagige Drainagefolie (OFD) oder ein mit der Drainagefolie umhüllter PU-Schwamm (OPFD) mittels Naht fixiert. Diese Drainagetypen unterscheiden sich im Durchmesser sowie in der Ansaugwirkung auf das Wundgewebe. Der parastomale Abszess wurde chirurgisch eröffnet und gespült. Daraufhin konnte der offenporige PU-Schwamm in die Wunde eingebracht werden. Der Unterdruckschlauch wurde über eine kleine Inzision wundfern ausgeleitet. Nach Wundverschluss per Naht konnte die Stomaplatte problemlos aufgeklebt werden. Ein Vakuum mit −125 mm Hg wurde etabliert. Die weiteren Verbandswechsel beinhalteten eine endoskopische Inspektion. Bei den erstmaligen Verbandswechseln von großporiger OPD und kleinporigerer OPFD musste die Wunde neu eröffnet und wieder chirurgisch verschlossen werden. Bei sauberen, granulierenden Wundverhältnissen wurde das Verbandsregime auf die kleinlumige OFD rotiert. Dieser Drainagetyp konnte ausschließlich endoskopisch gewechselt werden, eine weitere Wunderöffnung war nicht mehr notwendig.
Ergebnis
Durch die OPD konnte initial ein großflächiges Débridement und eine Wundverkleinerung erreicht werden, die Wunde musste für die Verbandswechsel jedoch wiedereröffnet werden. Auch bei der folgenden OPFD wurde die Wunde für den Verbandswechsel erneut eröffnet. Die doppellagige Folie um den PU-Schwamm führte hier zu einer geringeren Ansaugwirkung. Letztlich wurde mit der OFD eine rein endoskopisch zu versorgende Drainage etabliert, die keine weitere Manipulation an der Haut erforderte. Nach 16 Tagen endete die Therapie mit einer ausgeheilten Wunde und problemloser Stomaversorgung.
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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 PMCID: PMC7244863 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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Kim S, Kang SI. The effectiveness of negative-pressure wound therapy for wound healing after stoma reversal: a randomised control study (SR-PICO study). Trials 2020; 21:24. [PMID: 31907033 PMCID: PMC6945515 DOI: 10.1186/s13063-019-3925-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/21/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Although the wound-healing period for purse-string closure (PSC) after stoma reversal is longer than that required for the primary closure method, the rate of wound infection is reduced. The application of negative-pressure wound therapy (NPWT) can reduce the healing period for many types of wounds. Herein, we describe a planned trial to test the hypothesis that NPWT can reduce the healing period for PSC after stoma reversal. METHODS/DESIGN Patients undergoing stoma reversal will be recruited and allocated into intervention and control groups, with 1:1 randomisation. Patients in the control group will receive standard postsurgical wound care; patients in the intervention group will receive NPWT using the PICO™ system. The target sample size will be 38 patients, as this will provide 80% power at the 5% level of significance to detect a 7-day reduction in the wound-healing period in the intervention group compared to that in the control group. The primary endpoint will be the duration to wound healing, defined as the time to nearly complete epithelisation of the wound, without any discharge or surgical site infection (SSI). Secondary endpoints will be the SSI rate, length of postoperative hospital stay, number of wound dressings and visits to the hospital for wound dressing after discharge, total cost of wound dressings, and patient and observer scar assessment scale scores. DISCUSSION The results of this planned randomised controlled study will clarify the role of NPWT in patients undergoing stoma reversal and strengthen the rationale for choosing a dressing technique. TRIAL REGISTRATION Clinical Research Information Service (CRIS), KCT0004063. Registered on 6 June 2019.
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Affiliation(s)
- Sohyun Kim
- Department of Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415, South Korea
| | - Sung Il Kang
- Department of Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415, South Korea.
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10
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Factors affecting the morbidity and mortality of diverting stoma closure: retrospective cohort analysis of twelve-year period. Radiol Oncol 2019; 53:331-336. [PMID: 31553701 PMCID: PMC6765168 DOI: 10.2478/raon-2019-0037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/15/2019] [Indexed: 12/13/2022] Open
Abstract
Background Diverting stoma is often performed in rectal cancer surgery for reducing the consequences of possible anastomotic failure. Closing of stoma follows in most cases after a few months. The aim of our study was to evaluate morbidity and mortality after diverting stoma closure and to identify risk factors for complications of this procedure. Patients and methods At our department, we have performed a retrospective cohort analysis of data for 260 patients with diverting stoma closure from 2003 to 2015. Age, stoma type, patient's preoperative ASA score, surgical technique and time to stoma closure were investigated as factors which could influence the complication rate. Results 218 patients were eligible for investigation. Postoperative complications developed in 54 patients (24.8%). Most common complications were postoperative ileus (10%) and wound infection (5%). Four patients died (1.8%). There was no effect on complication rate regarding type of stoma, closing technique, patient's ASA status and patient age. The only factor influencing the complication rate was the time to stoma closure. We found that patients which had the stoma closed prior to 8 months after primary surgery had lower overall complication rate (p<0. 05). Conclusions To reduce overall complication rate, our data suggest a shorter period than 8 months after primary surgery before closure of diverting stoma. As diverting stoma closure is not a simple operation, all strategies should be taken to reduce significant morbidity and mortality rate.
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Garfinkle R, Savage P, Boutros M, Landry T, Reynier P, Morin N, Vasilevsky CA, Filion KB. Incidence and predictors of postoperative ileus after loop ileostomy closure: a systematic review and meta-analysis. Surg Endosc 2019; 33:2430-2443. [PMID: 31020433 DOI: 10.1007/s00464-019-06794-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/09/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Postoperative ileus (POI) is regarded as the most clinically significant morbidity following loop ileostomy closure; however, its incidence remains poorly understood. Our objective was therefore to determine the pooled incidence of POI after loop ileostomy closure and identify risk factors associated with its development. METHODS We systematically searched MEDLINE (via Ovid and PubMed), Embase, the Cochrane Library, Biosis Previews, and Scopus to identify studies reporting the incidence of POI in patients who underwent loop ileostomy closure. Two independent reviewers extracted data and appraised study quality. Cumulative incidence proportions were pooled across studies using a random-effects meta-analytic model. RESULTS Sixty-seven studies, including 9528 patients, met our inclusion criteria. The pooled estimate of POI was 8.0% (95% CI 6.9-9.3%; I2 = 74%). The estimated incidence varied by POI definition: studies with a robust definition of POI (n = 8) demonstrated the highest estimate of POI (12.4%, 95% CI 9.2-16.5%; I2 = 79%) while studies that did not report an explicit POI definition (n = 38) demonstrated the lowest estimate (6.7%, 95% CI 5.3-8.3%; I2 = 61%). Small bowel anastomosis technique (hand-sewn) and interval time from ileostomy creation to closure (longer time) were the factors most commonly associated with POI after loop ileostomy closure. However, most comparative studies were not powered to examine risk factors for POI. CONCLUSIONS POI is an important complication after loop ileostomy closure, and its incidence is dependent on its definition. More research aimed at studying this complication is required to better understand risk factors for POI after loop ileostomy closure.
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Affiliation(s)
- Richard Garfinkle
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Paul Savage
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada.,Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Marylise Boutros
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Tara Landry
- Medical Libraries, McGill University Health Center, Montreal, QC, Canada
| | - Pauline Reynier
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada
| | - Nancy Morin
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Carol-Ann Vasilevsky
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC, Canada
| | - Kristian B Filion
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada. .,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada. .,Department of Medicine, McGill University, Montreal, QC, Canada.
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12
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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: 25] [Impact Index Per Article: 4.2] [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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13
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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: 27] [Impact Index Per Article: 3.9] [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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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: 17] [Impact Index Per Article: 2.4] [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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15
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O'Leary DP, Carter M, Wijewardene D, Burton M, Waldron D, Condon E, Coffey JC, Peirce C. The effect of purse-string approximation versus linear approximation of ileostomy reversal wounds on morbidity rates and patient satisfaction: the 'STOMA' trial. Tech Coloproctol 2017; 21:863-868. [PMID: 29149428 DOI: 10.1007/s10151-017-1713-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 07/16/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ileostomy reversal is associated with surgical site infection (SSI) rates as high as 37%. Recent literature suggests that employing a purse-string approximation (PSA) of the reversal wound reduces this rate of SSI. Thus we wished to perform a randomised controlled trial to compare SSI rates in purse-string versus linear closure (PLC) wounds following ileostomy reversal. METHODS A randomised, controlled trial was conducted at University Hospital Limerick. Sixty-one patients undergoing ileostomy reversal were included. Thirty-four patients were randomised to PSA and 27 patients to linear closure. The primary endpoint was incidence of SSI and secondary endpoints measured were quality of life and satisfaction with cosmesis. Statistical analysis was performed on a per protocol basis using SPSS version 22.0. RESULTS Three patients in the PSA group developed an SSI compared to 8 in the PLC group at 30 days (8 vs 30%, p = 0.03). The mean time to SSI diagnosis was faster in the PSA group (3 vs 12.3 days, p = 0.08). Patients who developed SSI experienced a longer mean length of stay (6.8 vs 11.4 days, p = 0.012). On multivariate analysis, PLC was the only predictive factor of SSI formation (p < 0.001). There was no difference in patient satisfaction between the two study groups (p = 0.14). CONCLUSIONS PSA of wounds following ileostomy reversal significantly reduces SSI formation compared to linear approximation without any effect on patient satisfaction.
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Affiliation(s)
- D P O'Leary
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - M Carter
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - D Wijewardene
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - M Burton
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - D Waldron
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - E Condon
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - J C Coffey
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - C Peirce
- Department of Surgery, University Hospital Limerick, Limerick, Ireland.
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
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Abstract
Temporary stomas are frequently used in the management of diverticulitis, colorectal cancer, and inflammatory bowel disease. These temporary stomas are used to try to mitigate septic complications from anastomotic leaks and to avoid the need for reoperation. Once acute medical conditions have improved and after the anastomosis has been proven to be healed, stomas can be reversed. Contrast enemas, digital rectal examination, and endoscopic evaluation are used to evaluate the anastomosis prior to reversal. Stoma reversal is associated with complications including anastomotic leak, postoperative ileus, bowel obstruction, enterocutaneous fistula, and, most commonly, surgical site infection. Furthermore, many stomas, which were intended to be temporary, may not be reversed due to postoperative complications, adjuvant therapy, or prohibitive comorbidities.
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Affiliation(s)
- Karen L Sherman
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida
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17
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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: 1.0] [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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18
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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: 18] [Impact Index Per Article: 1.8] [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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Rubio-Perez I, Leon M, Pastor D, Diaz Dominguez J, Cantero R. Increased postoperative complications after protective ileostomy closure delay: An institutional study. World J Gastrointest Surg 2014; 6:169-174. [PMID: 25276286 PMCID: PMC4176777 DOI: 10.4240/wjgs.v6.i9.169] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 07/08/2014] [Accepted: 08/31/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the morbidity and complications associated to ileostomy reversal in colorectal surgery patients, and if these are related to the time of closure.
METHODS: A retrospective analysis of 93 patients, who had undergone elective ileostomy closure between 2009 and 2013 was performed. Demographic, clinical and surgical variables were reviewed for analysis. All complications were recorded, and classified according to the Clavien-Dindo Classification. Statistical univariate and multivariate analysis was performed, setting a P value of 0.05 for significance.
RESULTS: The patients had a mean age of 60.3 years, 58% male. The main procedure for ileostomy creation was rectal cancer (56%), and 37% had received preoperative chemo-radiotherapy. The average delay from creation to closure of the ileostomy was 10.3 mo. Postoperative complications occurred in 40% of the patients, with 1% mortality. The most frequent were ileus (13%) and wound infection (13%). Pseudomembranous colitis appeared in 4%. Increased postoperative complications were associated with delay in ileostomy closure (P = 0.041). Male patients had more complications (P = 0.042), mainly wound infections (P = 0.007). Pseudomembranous colitis was also associated with the delay in ileostomy closure (P = 0.003). End-to-end intestinal anastomosis without resection was significantly associated with postoperative ileus (P = 0.037).
CONCLUSION: Although closure of a protective ileostomy is a fairly common surgical procedure, it has a high rate of complications, and this must be taken into account when the indication is made. The delay in stoma closure can increase the rate of complications in general, and specifically wound infections and colitis.
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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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