Linear Versus Purse String Skin Closure at Loop Ileostomy Reversal.
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.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Detaljeret beskrivelse
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.
Undersøgelsestype
Undersøgelsestype
Tilmelding (Faktiske)
Tilmelding
Fase
Fase
- Ikke anvendelig
Kontakter og lokationer
Studiesteder
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-
KPK
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Peshawar, KPK, Pakistan, 25000
- Hayatabad Medical Complex
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-
Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
- Voksen
- Ældre voksen
Tager imod sunde frivillige
Beskrivelse
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
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Ingen (Åben etiket)
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
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Aktiv komparator: Linear Skin Closure
Participants undergoing loop ileostomy reversal receive conventional linear skin closure with primary approximation of wound edges.
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Closure of the ileostomy reversal wound using purse-string suturing technique, leaving a central gap for drainage to reduce infection risk.
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Aktiv komparator: Purse-String Skin Closure
Participants undergoing loop ileostomy reversal receive purse-string skin closure, leaving a small central opening to allow drainage.
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Closure of the ileostomy reversal wound using conventional linear suturing with complete approximation of skin edges.
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Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Surgical Site Infections Rate
Tidsramme: Within 30 days after surgery
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Proportion of participants who develop surgical site infection at the ileostomy reversal wound site, assessed using standard clinical criteria (redness, discharge, swelling, or pus).
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Within 30 days after surgery
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Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
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Length of Hospital Stay
Tidsramme: From surgery until hospital discharge (up to 7 days after surgery)
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Duration of hospital stay measured in days from the date of surgery to discharge.
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From surgery until hospital discharge (up to 7 days after surgery)
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Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Publikationer og nyttige links
Generelle publikationer
- Ameer A, Mirza MB, Talat N. The Outcome of Purse-string Versus Conventional Wound Closure Techniques in Patients Undergoing Stoma Reversal: A Randomized Controlled Trial. J Pediatr Surg. 2024 Jun;59(6):1186-1189. doi: 10.1016/j.jpedsurg.2023.10.062. Epub 2023 Oct 30.
- O'Leary DP, Carter M, Wijewardene D, Burton M, Waldron D, Condon E, Coffey JC, Peirce C. The effect of purse-string approximation versus linear approximation of ileostomy reversal wounds on morbidity rates and patient satisfaction: the 'STOMA' trial. Tech Coloproctol. 2017 Nov;21(11):863-868. doi: 10.1007/s10151-017-1713-x. Epub 2017 Nov 17.
- Aga E, Keinan-Boker L, Eithan A, Mais T, Rabinovich A, Nassar F. Surgical site infections after abdominal surgery: incidence and risk factors. A prospective cohort study. Infect Dis (Lond). 2015;47(11):761-7. doi: 10.3109/23744235.2015.1055587. Epub 2015 Jun 26.
- Nota SP, Braun Y, Ring D, Schwab JH. Incidence of surgical site infection after spine surgery: what is the impact of the definition of infection? Clin Orthop Relat Res. 2015 May;473(5):1612-9. doi: 10.1007/s11999-014-3933-y.
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Faktiske)
Primær færdiggørelse
Studieafslutning (Faktiske)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- HMC-QAD-RCT-3
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