Purse-string closure versus conventional wound closure technique following stoma reversal: a prospective randomized controlled trial

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Abstract

Background
Stoma reversal is associated with a high risk of postoperative wound infection of up to 41%. The conventional method of skin closure during stoma reversal has been primary skin closure (PC) with interrupted nonabsorbable sutures. The purse-string skin closure (PSSC) method creates a hole in the center of the wound to promote secondary intentional healing. This alternative technique of skin closure can reduce the risk of wound infection.
Patients and methods
A prospective randomized controlled trial was conducted on all patients undergoing stoma closure at Ain Shams University hospitals between September 2020 and December 2021. Patients were divided using computerized randomization into two groups based on skin closure technique: PC or PSSC.
Results
A total of 52 patients were included: 27 patients underwent primary closure (group 1) and 25 patients underwent PSSC (group 2). There was a statistically significant increase in the incidence of wound complications in the PC group compared with the PSSC group. Seroma occurred in 12 (44.4%) cases in group 1 compared with no cases in group 2. There were 10 (37.0%) wound infection cases in group 1, and three (12.0%) in group 2. There was prolonged healing time among the PC group (4.22±1.48 weeks) compared with the PSSC group (3.16±0.62 weeks). In terms of patient satisfaction, patients in the PSSC group were more satisfied, having more favorable survey-based satisfaction.
Conclusion
PSSC for stoma reversal significantly reduces wound complications and surgical site infection and shortens the wound healing time.

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