Korean J Gastroenterol.  2022 Mar;79(3):109-117. 10.4166/kjg.2021.149.

Comparison between Wound Closure Methods in the Reversal of Diverting Ileostomy

• Oh YH
• Jeong JY
• Kim KT
• Kim JY

• KMID: 2527478
• DOI: http://doi.org/10.4166/kjg.2021.149

Abstract

Background/Aims
The objective of this study was to determine the more appropriate wound-closure method by comparing the effectiveness of two methods in a group of patients who underwent ileostomy repair.
Methods
The study conducted after obtaining the approval of the Institutional Review Board (IRB) included 58 patients ≥19 years of age who underwent ileostomy at the Department of Surgery at the Presbyterian Medical Center. This was a retrospective, single-center trial. Patients who underwent ileostomy closure between January 2011 and September 2017 were assigned to the primary wound-closure (PC, n=25) group and the purse-string wound-closure (PSC, n=33) group. Post-repair complications, such as wound infection, delayed healing, and patient satisfaction related to wound management, were investigated and compared according to the wound-closure method.
Results
The PSC group had a significantly lower surgical site infection rate than the PC group (0% vs. 44%, p<0.001). The wound-healing period was also significantly different between the PC and PSC groups (mean 27.18 days vs. 20.96 days, p=0.023). However, the postoperative wound-healing delay of >30 days was not significantly different (39% vs. 20%, p=0.114). In addition, there were no significant differences in the response to questionnaires on patient satisfaction between the two groups.
Conclusions
PSC has a lower surgical site infection rate and the wound-healing delay was not very different from that of PC. Therefore, if patients are at risk of wound infection, such as in severe wound contamination, long operating time, and immunocompromised conditions, we should consider PSC as a wound closure method of choice.

Keyword

Ileostomy reversal; Purse-string wound closure; Primary wound closure

Figure

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  Fig. 1 Flowchart depicting patient enrollment.

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  Fig. 2 Purse-string closure. The subcuticular continuous suture was performed using nylon 1/0 and then the wound was approximated. It has a 7-10-mm opening which facilitates wound drainage.

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  Fig. 3 Scar after primary closure.

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  Fig. 4 Scar after purse-string closure.

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  Fig. 5 Patient satisfaction. PC, primary wound-closure; PSC, purse-string wound-closure.

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