Purse-string closure versus conventional primary closure of wound following stoma reversal: Meta-analysis of randomized controlled trials.

Abstract

PURPOSE:

Surgical site infection (SSI) is one of the most frequent complications after stoma closure and the optimal skin closure technique is still not clear. The goal of this review was to compare outcomes with purse-string closure technique (PSC) versus conventional closure technique (CCT) for skin closure after stoma reversal.

METHODS:

We performed a systematic review and meta-analysis of available randomized controlled trials (RCTs) to compare SSI rate within 30 days, operative time, hospital stay, incisional hernia and intestinal obstruction rates between PSC and CCT.

RESULTS:

The pooled analysis of 5 studies showed a statically significant lower rate of SSI in favor of PSC compared to CCT (OR -0.24; 95% CI -0.32, - 0.15; p < 0.00001). No statistically significant differences were observed in the operative time (OR -0.05; 95% CI -3.95, 3.84; p = 0.98) and in the length of hospital stay (OR -0.20; 95% CI -0.76, 0.36; p = 0.48), between the two techniques. Additionally, two out of the five studies provided data on incisional hernia and intestinal obstruction and the pooled analysis revealed no statistically significant differences between PSC and CCT techniques: incisional hernia (OR 0.81, 95% CI 0.27-2.47; p = 0.71) and intestinal obstruction (OR 1.07, 95% CI 0.41-2.84; p = 0.88).

CONCLUSIONS:

The analysis of 5 RCTs showed that SSI rate is statistically significant lower when PSC is performed, compared to CCT. Whereas, no significant differences were found between the two techniques with regards to operative time, length of hospital stay, incisional hernia and intestinal obstruction rates.

• Authors: Fabio Rondelli, Laura Franco, Ruben Carlo Balzarotti Canger, Graziano Ceccarelli, Cecilia Becattini, Walter Bugiantella
• Journal: International journal of surgery (London, England) (Int J Surg) Vol. 52 Pg. 208-213 (Apr 2018) ISSN: 1743-9159 [Electronic] England
• PMID: 29474885 (Publication Type: Comparative Study, Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Topics

• Humans
• Incisional Hernia (etiology)
• Intestinal Obstruction (etiology)
• Length of Stay
• Operative Time
• Randomized Controlled Trials as Topic
• Surgical Stomas
• Surgical Wound Infection (etiology)
• Wound Closure Techniques (adverse effects)