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Randomized Clinical Trial of Intestinal Ostomy Takedown Comparing Pursestring Wound Closure vs Conventional Closure to Eliminate the Risk of Wound Infection

Camacho-Mauries, Daniel M.D.; Rodriguez-Díaz, José Luis M.D.; Salgado-Nesme, Noel M.D.; González, Quintín H. M.D.; Vergara-Fernández, Omar M.D.

doi: 10.1097/DCR.0b013e31827888f6
Original Contribution: Benign Colorectal Disease

BACKGROUND: The use of temporary stomas has been demonstrated to reduce septic complications, especially in high-risk anastomosis; therefore, it is necessary to reduce the number of complications secondary to ostomy takedowns, namely wound infection, anastomotic leaks, and intestinal obstruction.

OBJECTIVE: To compare the rates of superficial wound infection and patient satisfaction after pursestring closure of ostomy wound vs conventional linear closure.

DESIGN: Patients undergoing colostomy or ileostomy closure between January 2010 and February 2011 were randomly assigned to linear closure (n = 30) or pursestring closure (n = 31) of their ostomy wound. Wound infection within 30 days of surgery was defined as the presence of purulent discharge, pain, erythema, warmth, or positive culture for bacteria. Patient satisfaction, healing time, difficulty managing the wound, and limitation of activities were analyzed with the Likert questionnaire.

RESULTS: The infection rate for the control group was 36.6% (n = 11) vs 0% in the pursestring closure group (p < 0.0001). Healing time was 5.9 weeks in the linear closure group and 3.8 weeks in the pursestring group (p = 0.0002). Seventy percent of the patients with pursestring closure were very satisfied in comparison with 20% in the other group (p = 0.0001).

LIMITATIONS: This study was limited by the heterogeneity in the type of stoma in both groups.

CONCLUSION: The pursestring method resulted in the absence of infection after ostomy wound closure (shorter healing time and improved patient satisfaction).

Colorectal Surgery Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

Financial Disclosure: None reported.

Podium presentation at the meeting of The American Society of Colon and Rectal Surgeons, San Antonio, TX, June 2 to 6, 2012.

Correspondence: Daniel Ignacio Camacho-Mauries, M.D., Colorectal Surgery Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Parroquia 313-103 Col. Del Valle, CP 03100 Del. Benito Juárez, Mexico. E-mail:

© The ASCRS 2013