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Pursestring Closure versus Conventional Primary Closure Following Stoma Reversal to Reduce Surgical Site Infection Rate: A Meta-analysis of Randomized Controlled Trials

Hsieh, Meng-Chiao M.D.1,2; Kuo, Liang-Tseng M.D.2,3; Chi, Ching-Chi M.D., M.M.S., D.Phil.2,4–6; Huang, Wen-Shih M.D.1,5; Chin, Chih-Chien M.D.1,5

Diseases of the Colon & Rectum: August 2015 - Volume 58 - Issue 8 - p 808–815
doi: 10.1097/DCR.0000000000000401
Current Status

BACKGROUND: Stoma reversal is a surgical procedure commonly used following temporary defunctioning stoma surgery. Surgical site infection is one of the most common postoperative morbidities. A few skin closure methods have been developed to decrease surgical site infection. However, the optimal skin closure method is still in debate.

OBJECTIVE: The aim of this study was to compare the surgical site infection rate and other postoperative outcomes between the pursestring closure and conventional primary closure techniques.

DATA SOURCES: We searched the MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for relevant trials.

STUDY SELECTION: We conducted a meta-analysis of randomized controlled trials that compared the surgical outcomes following pursestring closure and conventional primary closure techniques.

INTERVENTION: We conducted the meta-analysis by using the random-effects model.

MAIN OUTCOME MEASURES: The primary outcome of interest was surgical site infection following stoma reversal within 30 days after operation.

RESULTS: This meta-analysis included 4 randomized controlled trials with a total of 319 participants (162 in the pursestring closure group and 157 in the conventional primary closure group). Compared with the conventional primary closure group, the pursestring closure group had a significant decrease in surgical site infection (risk difference, –0.25; 95% CI, –0.36 to –0.15; p < 0.00001; number needed to treat = 4) and higher satisfaction with cosmetic outcomes (standard mean difference, 0.7; 95% CI, 0.13–1.27; p = 0.02). No other significant differences in operative time, length of hospital stay, and wound healing time were found between the 2 groups.

LIMITATIONS: This study was limited to the lack of double blinding and long-term follow-up in the included trials.

CONCLUSIONS: Pursestring closure has significantly fewer surgical site infections and achieves better cosmetic outcomes following stoma reversal than conventional primary closure.

1 Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan

2 Centre for Evidence-Based Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan

3 Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan

4 Department of Dermatology, Chang Gung Memorial Hospital, Chiayi, Taiwan

5 Graduate Institutes of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan

6 College of Medicine, Chang Gung University, Taoyuan, Taiwan

Financial Disclosure: None reported.

Correspondence: Ching-Chi Chi, M.D., M.M.S., D.Phil., Department of Dermatology, Chang Gung Memorial Hospital, Chiayi, Taiwan, No 6, Sec West, Chia-Pu Rd, Puzih, Chiayi 61363, Taiwan. E-mail: chingchi@cgmh.org.tw; chingchichi@gmail.com

© 2015 The American Society of Colon and Rectal Surgeons