Clinical Trial on the Incidence of Wound Infection and Patient Satisfaction After Stoma Closure: Comparison of Two Skin Closure Techniques

Abstract

PurposeSurgical 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.MethodsThis 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.ResultsSSI 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).ConclusionAfter 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.

Effect of a Purse-String Approximation Following Stoma Takedown on Wound Infection and Satisfaction

“…The purse-string closure method has been criticized because of the time required for wound healing. However, the wound healing time following purse-string closure has been reported to be shorter than that following primary closure [ 5 , 7 ], which is the same as the results reported by the authors of "Clinical trial on the incidence of wound infection and patient satisfaction after stoma closure: Comparison of two skin closure techniques" [ 9 ]. The way in which an open wound affects the quality of life of a patient needs to be investigated further because a higher infection rates is also associated with patient dissatisfaction.…”

“…The authors of "Clinical trial on the incidence of wound infection and patient satisfaction after stoma closure: Comparison of two skin closure techniques" comparing purse-string with primary closure for ileostomy wounds demonstrated a lower incidence of SSI and a higher patient satisfaction when ileostomy wounds were closed using the purse-string method [ 9 ]. Although the study was a retrospective one, the patient populations in the two arms of the trial were well matched in most respects such as indications, types of stoma, and times to stoma closure.…”

Considerations in Stoma Reversal

“…This study, however, revealed longer time to complete healing with the purse-string technique (32 vs. 19 days; p < 0.0001) when compared with primary closure. 42 Data have repeatedly suggested that purse-string closure of the stoma closure site results in lower surgical site infections and improved patient satisfaction when compared with primary closure. 35,36,[41][42][43][44][45] Hartmann's Reversal…”

The technique for less infectious and earlier healing of stoma closure wound: negative pressure wound therapy with instillation and dwelling followed by primary closure

“…Purse-string suturing has one of the lowest infection rates, and its usefulness has been demonstrated [ 1 , 4 , 11 ]. However, this method can take up to 30 days for granulation and epithelialization [ 13 ]. Continuous wound care and outpatient visits are required until the wound is healed, and it may be difficult for elderly patients to perform self-care procedures such as cleaning the wound.…”