Linear Versus Purse String Skin Closure at Loop Ileostomy Reversal.

May 7, 2026 updated by: Gohar Ali, Hayat Abad Medical Complex, Peshawar

Comparison of Efficacy Between Linear Versus Purse String Skin Closure at Loop Ileostomy Reversal. A Randomized Control Trial.

This study is a randomized controlled trial designed to compare two commonly used skin closure techniques-linear closure and purse-string closure-after loop ileostomy reversal surgery. Surgical site infection (SSI) is one of the most frequent complications following stoma closure, leading to increased patient discomfort, prolonged hospital stay, and higher healthcare costs.

In this trial, eligible adult patients undergoing elective loop ileostomy reversal are randomly assigned to either linear skin closure or purse-string skin closure. The purse-string technique leaves a small central opening that allows drainage, which may reduce infection risk, whereas linear closure involves complete approximation of the wound edges.

All patients are managed according to standard hospital protocols and are followed during their hospital stay and for 30 days after surgery. The primary outcome is the occurrence of surgical site infection. Secondary outcomes include length of hospital stay and operative time.

The purpose of this study is to determine which closure technique provides better outcomes in terms of reducing postoperative infections and improving recovery. The findings may help guide surgeons in selecting the most effective and safe method for skin closure after ileostomy reversal.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Loop ileostomy reversal is a commonly performed surgical procedure; however, it is associated with a considerable risk of postoperative complications, particularly surgical site infection (SSI). Reported SSI rates after stoma closure range from 4% to over 20%, making it one of the most frequent causes of postoperative morbidity. The development of SSI not only delays wound healing but also contributes to prolonged hospital stay, increased healthcare costs, and reduced patient satisfaction.

Multiple techniques for skin closure following ileostomy reversal have been described, with conventional linear closure and purse-string closure being the most widely practiced. Linear closure involves primary approximation of the wound edges, resulting in complete closure of the skin. In contrast, the purse-string technique leaves a small central opening that allows continuous drainage of wound exudate, which may reduce bacterial colonization and lower the risk of infection.

Previous studies have suggested that purse-string closure may be associated with lower SSI rates and improved cosmetic outcomes compared to linear closure. However, linear closure remains widely used due to its technical simplicity and shorter operative time. Despite available evidence, there is still variability in clinical practice, and further high-quality randomized controlled trials are needed to establish the optimal technique.

This randomized controlled trial was conducted at the Department of General Surgery, MTI-Hayatabad Medical Complex, Peshawar. A total of 252 patients meeting the inclusion criteria were enrolled and randomly allocated into two groups: linear skin closure (Group A) and purse-string skin closure (Group B). Block randomization was used to ensure balanced group allocation.

All patients underwent ileostomy reversal according to standardized surgical protocols. Preoperative optimization, including management of comorbid conditions such as diabetes mellitus and hypertension, was performed as per institutional guidelines. Postoperatively, patients were monitored during their hospital stay and followed up for 30 days to assess outcomes.

The primary outcome of the study was the frequency of surgical site infection within 30 days of surgery. Secondary outcomes included length of hospital stay and duration of surgery. Data were collected using a structured proforma and analyzed using appropriate statistical methods.

The aim of this study is to provide evidence on the comparative effectiveness of purse-string versus linear skin closure techniques in reducing postoperative complications following ileostomy reversal. The results are expected to support evidence-based surgical practice and improve patient outcomes.

Study Type

Interventional

Enrollment (Actual)

252

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Pakistan
    • KPK
      • Peshawar, KPK, Pakistan, 25000
        • Hayatabad Medical Complex

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Patients aged 20 to 70 years
  • Both male and female patients
  • Patients undergoing elective loop ileostomy reversal
  • American Society of Anesthesiologists (ASA) physical status I-II
  • Patients who provide informed consent

Exclusion Criteria:

  • Patients with active stoma site infection (e.g., fever with total leukocyte count >11,000/mm³)
  • Patients not planned for ileostomy reversal
  • Patients with severe comorbid conditions (ASA III or above)
  • Patients unwilling to participate in the study

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Linear Skin Closure
Participants undergoing loop ileostomy reversal receive conventional linear skin closure with primary approximation of wound edges.
Procedure: Purse-String Skin Closure
Closure of the ileostomy reversal wound using purse-string suturing technique, leaving a central gap for drainage to reduce infection risk.
Active Comparator: Purse-String Skin Closure
Participants undergoing loop ileostomy reversal receive purse-string skin closure, leaving a small central opening to allow drainage.
Procedure: Linear Skin Closure
Closure of the ileostomy reversal wound using conventional linear suturing with complete approximation of skin edges.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Surgical Site Infections Rate
Time Frame: Within 30 days after surgery
Proportion of participants who develop surgical site infection at the ileostomy reversal wound site, assessed using standard clinical criteria (redness, discharge, swelling, or pus).
Within 30 days after surgery

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Length of Hospital Stay
Time Frame: From surgery until hospital discharge (up to 7 days after surgery)
Duration of hospital stay measured in days from the date of surgery to discharge.
From surgery until hospital discharge (up to 7 days after surgery)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Hayat Abad Medical Complex, Peshawar

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

June 22, 2020

Primary Completion (Actual)

July 1, 2025

Study Completion (Actual)

July 31, 2025

Study Registration Dates

First Submitted

May 1, 2026

First Submitted That Met QC Criteria

May 1, 2026

First Posted (Actual)

May 7, 2026

Study Record Updates

Last Update Posted (Actual)

May 12, 2026

Last Update Submitted That Met QC Criteria

May 7, 2026

Last Verified

May 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • HMC-QAD-RCT-3

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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