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Pursestring Closure of the Stoma Site Leads to Fewer Wound Infections: Results From a Multicenter Randomized Controlled Trial

Lee, Janet T. M.D.1; Marquez, Thao T. M.D., M.S.2; Clerc, Daniel M.D.3; Gie, Olivier M.D.3; Demartines, Nicolas M.D.3; Madoff, Robert D. M.D.1; Rothenberger, David A. M.D.1; Christoforidis, Dimitrios M.D.3

doi: 10.1097/DCR.0000000000000209
Original Contributions: Benign Colorectal Disease

BACKGROUND: Surgical site infection after stoma reversal is common. The optimal skin closure technique after stoma reversal has been widely debated in the literature.

OBJECTIVE: We hypothesized that pursestring near-complete closure of the stoma site would lead to fewer surgical site infections compared with conventional primary closure.

DESIGN: This study was a parallel prospective multicenter randomized controlled trial.

SETTINGS: This study was conducted at 2 university medical centers.

PATIENTS: Patients (N = 122) presenting for elective colostomy or ileostomy reversal were selected.

INTERVENTIONS: Pursestring versus conventional primary closure of stoma sites were compared.

MAIN OUTCOME MEASURES: Stoma site surgical site infection within 30 days of surgery, overall surgical site infection, delayed healing (open wound for >30 days), time to wound epithelialization, and patient satisfaction were the primary outcomes measured.

RESULTS: The pursestring group had a significantly lower stoma site infection rate (2% vs 15%, p = 0.01). There was no difference in delayed healing or patient satisfaction between groups. Time to epithelialization was measured in only 51 patients but was significantly longer in the pursestring group (34.6 ± 20 days vs 24.1 ± 17 days, p = 0.02).

LIMITATIONS: This study was limited by the variability in procedures and surgeons, the limited follow-up after 30 days, and the inability to perform blinding.

CONCLUSION: Pursestring closure after stoma reversal has a lower risk of stoma site surgical site infection than conventional primary closure, although wounds may take longer to heal with the use of this approach. Registration number: NCT01713452 (www.clinicaltrials.gov).

1Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota

2Department of Surgery, Mercy Clinic, Saint Louis, Missouri

3Division of Visceral Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

Financial Disclosures: None reported.

Poster presentation at the meeting of the American Society of Colon and Rectal Surgeons, Phoenix, AZ, April 27 to May 1, 2013.

Correspondence: Janet T. Lee, M.D., 420 Delaware St SE, MMC 195, Minneapolis, MN 55455. E-mail: Leex1203@umn.edu

© 2014 The American Society of Colon and Rectal Surgeons