Prophylactic negative-pressure wound therapy after ileostomy reversal for the prevention of wound healing complications in colorectal cancer patients: a randomized controlled trial

Abstract

Background The aim of this study was to assess the usefulness of protective negative-pressure wound therapy (NPWT) in the reduction of wound healing complications (WHC) and surgical site infections (SSI) after diverting ileostomy closure in patients who underwent surgery for colorectal cancer. Methods In this prospective randomized clinical trial in a tertiary academic surgical center, patients who had colorectal cancer surgery with protective loop ileostomy and were scheduled to undergo ileostomy closure with primary wound closure from January 2016 to December 2018 were randomized to be treated with or without NPWT. The primary endpoint was the incidence of WHC. Secondary endpoints were incidence of SSI, length of postoperative hospital stay (LOS), and length of complete wound healing (CWH) time. Results We enrolled 35 patients NPWT (24 males [68.6%]; mean age 61.6 ± 11.3 years), with NPWT and 36 patients (20 males [55.6%]; mean age 62.4 ± 11.3 years) with only primary wound closure (control group). WHC was observed in 11 patients (30.6%) in the control group and 3 (8.57%) in the NPWT group (p = 0.020). Patients in the NPWT group had a significantly lower incidence of SSI (2 [5.71%] vs. 8 [22.2%] in the control group; p = 0.046) as well as significantly shorter median CWH (7 [7–7] days vs. 7 [7–15.5] days, p = 0.030). There was no difference in median LOS between groups (3 [2.5–5] days in the control group vs. 4 [2–4] days in the NPWT group; p = 0.072). Conclusions Prophylactic postoperative NPWT after diverting ileostomy closure in colorectal cancer patients reduces the incidence of WRC and SSI. Clinical trial registration clinicaltrials.gov (NCT04088162).

Effect of closed incision negative pressure wound therapy on incidence rate of surgical site infection after stoma reversal: a pilot study.

“…Recently, Wierdak et al demonstrated in a randomized controlled trial that utility of ciNPWT after ileostomy closure in colorectal cancer patients reduces the incidence of wound healing complications and surgical site infection [ 43 ]. Such promising outcomes may have significant implications regarding early stoma reversal surgery, even before adjuvant chemotherapy in colorectal cancer patients as suggested by Kłęk et al [ 44 ].…”

Closed-Wound Negative Pressure Therapy Dressing After Loop Ostomy Closure.

“…Nevertheless, a few studies assessed the effect of NPWT application after loop ostomy closure [8][9][10]. A recently published randomized controlled study of NPWT in primarily closed wounds after loop ileostomy closure described a iSSI rate of 5.7% in the NPWT group vs. 19% without NPWT [9].…”

“…Nevertheless, a few studies assessed the effect of NPWT application after loop ostomy closure [8][9][10]. A recently published randomized controlled study of NPWT in primarily closed wounds after loop ileostomy closure described a iSSI rate of 5.7% in the NPWT group vs. 19% without NPWT [9]. The present series revealed a similar rate of iSSI in the NPWT group, but lower rates in the control group, which may explain the lack of signi cant difference in the present comparison.…”

“…Closed-wound negative pressure wound therapy (NPWT) has been suggested as a iSSI reducing alternative in high-risk wounds [7]. However, data on closed-wound NPWT application after loop ostomy closure are scarce, despite encouraging preliminary results regarding clinical bene ts and ease of use [8][9][10].…”

Negative-pressure wound therapy after stoma reversal in colorectal surgery: a randomized controlled trial

“…Single-use negative-pressure wound therapy (NPWT) may represent a strategy to reduce the SSI rate while shortening healing times compared with conventional wound dressing. Previous randomized studies were focused on patients with either inflammatory bowel disease or cancer, and led to conflicting results 16 , 17 . Moreover, these trials failed to assess important patient-related outcomes, such as pain, aesthetic satisfaction and quality of life.…”