Randomized Controlled Trial of Prophylactic Negative-Pressure Wound Therapy at Ostomy Closure for the Prevention of Delayed Wound Healing and Surgical Site Infection in Patients with Ulcerative Colitis

Abstract

Background/Aims: Although negative-pressure wound therapy (NPWT) is likely advantageous for wound healing, the efficacy and safety of its prophylactic use remain unclear for digestive surgery. We performed a prospective randomized controlled study to evaluate the efficacy and safety of this procedure during ileostomy closure. Methods: We conducted a prospective, randomized study between November 2014 and September 2015. Patients with ulcerative colitis scheduled to undergo ileostomy closure with purse-string suture (PSS) were randomly divided into groups with or without NPWT. The primary endpoint was complete wound healing. The secondary endpoints were incidences of wound complications. Results: A total of 31 patients with PSS alone and 28 patients with PSS + NPWT were enrolled. Wound infection was observed in 1 patient in the PSS-alone condition and 3 patients in the PSS + NPWT condition (p = 0.76). The mean duration of complete wound healing was 37.6 ± 11.7 days in the PSS-alone condition and 33.5 ± 10.0 days in the PSS + NPWT condition (p = 0.18). Conclusion: Although no adverse effects were observed in this series, the efficacy of PSS + NPWT was not confirmed. Further clarification of the indication of prophylactic NPWT and its efficacy must be obtained, and the efficacy and safety of NPWT in different dirty/infected surgeries should be evaluated.

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

“…Several clinical trials have investigated the usefulness of postoperative NPWT in reducing postoperative infections, but the majority of them have been conducted in fields other than gastrointestinal surgery [15]. Only a few studies have been conducted in the field of general, oncological, or digestive surgery [14], and only one article has described the use of NPWT as a postoperative dressing in patients after diverting ileostomy closure [22]. The results of this study differ from our observations.…”

“…The results of this study differ from our observations. In the cited study, the wound after ileostomy was closed using the purse-string suture technique; for this reason, even in the group without complications, the wound healing time was longer than 30 days [22].…”

Decreased superficial surgical site infections, shortened hospital stay, and improved quality of life due to incisional negative pressure wound therapy after reversal of double loop ileostomy

“…Blackham et al announced SSSI rates of 6.7% (iNPWT) vs. 17.2% (SSD) ( p = 0.035) in patients operated due to abdominal carcinoma . Uchino et al reported SSSI rates of 10.7% (iNPWT) vs. 3.2% (SSD) in ulcerative colitis patients undergoing reversal of double loop ileostomy …”

Chinese Trauma Surgeon Association for management guidelines of vacuum sealing drainage application in abdominal surgeries—Update and systematic review

“…A total of 35 articles discussed prophylactic VSD (pVSD) for abdominal incisions with primary suture, of which 6 were RCTs 32 , 33 , 34 , 35 , 36 , 37 and 29 were observational studies. 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 …”

“… 61 A total of twenty studies were included in the clean-contaminated surgery group, of which 13 observational studies showed that pVSD reduced the incidence of SSIs for clean-contaminated incisions, 38 , 39 , 40 , 41 , 43 , 44 , 45 , 60 , 62 , 63 , 64 , 66 , 70 three RCTs showed that pVSD reduced the incidence SSIs, 34 , 35 , 36 and another three RCTs showed that pVSD did not have apparent advantages in reducing infection incidences. 32 , 33 , 37 …”