Meng-Chiao Hsieh1, Liang-Tseng Kuo, Ching-Chi Chi, Wen-Shih Huang, Chih-Chien Chin. 1. 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.
Abstract
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.
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.
Authors: D P O'Leary; M Carter; D Wijewardene; M Burton; D Waldron; E Condon; J C Coffey; C Peirce Journal: Tech Coloproctol Date: 2017-11-17 Impact factor: 3.781
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Authors: Mauro Podda; Patricia Sylla; Gianluca Baiocchi; Michel Adamina; Vanni Agnoletti; Ferdinando Agresta; Luca Ansaloni; Alberto Arezzo; Nicola Avenia; Walter Biffl; Antonio Biondi; Simona Bui; Fabio C Campanile; Paolo Carcoforo; Claudia Commisso; Antonio Crucitti; Nicola De'Angelis; Gian Luigi De'Angelis; Massimo De Filippo; Belinda De Simone; Salomone Di Saverio; Giorgio Ercolani; Gustavo P Fraga; Francesco Gabrielli; Federica Gaiani; Mario Guerrieri; Angelo Guttadauro; Yoram Kluger; Ari K Leppaniemi; Andrea Loffredo; Tiziana Meschi; Ernest E Moore; Monica Ortenzi; Francesco Pata; Dario Parini; Adolfo Pisanu; Gilberto Poggioli; Andrea Polistena; Alessandro Puzziello; Fabio Rondelli; Massimo Sartelli; Neil Smart; Michael E Sugrue; Patricia Tejedor; Marco Vacante; Federico Coccolini; Justin Davies; Fausto Catena Journal: World J Emerg Surg Date: 2021-07-02 Impact factor: 5.469