Comparison of surgical techniques for stoma closure: A retrospective study of purse-string skin closure versus conventional skin closure following ileostomy and colostomy reversal

Yuma Wada, Norikatsu Miyoshi, Masayuki Ohue, Shingo Noura, Shiki Fujino, Keijirou Sugimura, Hirofumi Akita, Masaaki Motoori, Kunihito Gotoh, Hidenori Takahashi, Shogo Kobayashi, Takeshi Ohmori, Yoshiyuki Fujiwara, Masahiko Yano, Yuma Wada, Norikatsu Miyoshi, Masayuki Ohue, Shingo Noura, Shiki Fujino, Keijirou Sugimura, Hirofumi Akita, Masaaki Motoori, Kunihito Gotoh, Hidenori Takahashi, Shogo Kobayashi, Takeshi Ohmori, Yoshiyuki Fujiwara, Masahiko Yano

Abstract

The aim of this study was to compare the incidence of postoperative complications, including superficial incisional surgical site infection (SSI) following purse-string skin closure (PS) and conventional skin closure with a drainage tube (CD) following stoma closure. A total of 55 consecutive patients who underwent loop colostomy and loop ileostomy closures in our hospital between October, 2011 and September, 2014 were retrospectively assessed. The patients were divided into two groups, namely the PS group (26 patients) and the CD group (29 patients). There were no significant differences in the characteristics of the patients between the two groups. The baseline and operative characteristics also did not differ significantly between the two groups. However the incidence of superficial incisional SSI was lower in the PS group compared to that in the CD group (0 vs. 13.8%, respectively; P=0.049). The overall incidence of complications did not differ significantly between the two groups (P=0.313). The duration of postoperative hospital stay in the PS group was shorter compared to that in the CD group. In conclusion, the results of this study suggest that PS may an effective technique to reduce the incidence of superficial incisional SSI. This technique appears to be superior to the conventional technique, allowing for better cosmesis.

Keywords: drainage; purse-string skin closure; stoma closure; surgical site infection.

Figures

Figure 1.
Figure 1.
Surgical procedure of the purse-string skin closure. (A and B) following irrigation with saline, an open-ileostomy/colostomy was closed by sutures. The skin was cut around the sutured stoma while maintaining a ~3–5 mm margin.
Figure 2.
Figure 2.
Postoperative picture of the purse-string skin closure. Approximately 5 mm of the center of the wound were mainained open to drain the discharge from the subcutaneous wound.
Figure 3.
Figure 3.
Postoperative picture 1 month following purse-string skin closure. The scar became smaller, allowing for better cosmesis.

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