Skip to main content

Advertisement

SpringerLink
Log in

The use of purse-string skin closure in loop ileostomy reversals leads to lower wound infection rates—a single high-volume centre experience

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Wound infections affect not only the individual patient but lead to an increase in medical costs. After ileostomy reversal, surgical site infections are a common problem. The objective of the study was to compare the infection rates of purse-string and conventional skin closure techniques in a high volume setting.

Methods

Patients undergoing ileostomy reversal at the Goethe University Hospital between January 2009 and August 2012 were retrospectively analysed regarding surgical site infections and associated risk factors. Patients received either conventional skin closure (running, interrupted or stapled suturing; group C) or subcuticular purse-string suture (group PS).

Results

In total, 114 patients have been analysed. Conventional wound closure was performed in 81 patients and 33 patients received purse-string skin closure. The groups did not differ regarding age, gender, indication for ileostomy, previous chemotherapy, and operation time. Median hospital stay was 7 days (3–34) in group PS and 8 (3–53) in group C (p = 0.15). Wound infections only occurred in groups C (n = 10, 12 %) compared to group PS (n = 0; 0 %; p = 0.034), and the wound closure technique was the only significant factor associated with surgical site infection. Surgery performed by a resident under supervision was not a risk factor for complications compared to the procedure done by a senior surgeon (p = 0.73).

Conclusion

This study reveals an advantage of the purse-string skin closure technique in ileostomy reversals analysing a large cohort of patients. Therefore, we recommend the use of the purse-string skin closure in ileostomy reversals as one way to lower wound infection rates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Gastmeier P, Behnke M, Breier AC, Piening B, Schwab F, Dettenkofer M, Geffers C (2012) Healthcare-associated infection rates: measuring and comparing. Experiences from the German National Nosocomial Infection Surveillance System (KISS) and from other surveillance systems. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 55(11-12):1363–1369, German

    Article  CAS  Google Scholar 

  2. Matthiessen P, Hallbook O, Rutegard J, Simert G, Sjodahl R (2007) Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg 246:207–214

    Article  PubMed Central  PubMed  Google Scholar 

  3. Law WI, Chu KW, Ho JW, Chan CW (2000) Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision. Am J Surg 179:92–96

    Article  CAS  PubMed  Google Scholar 

  4. Edwards DP, Leppington-Clarke A, Sexton R, Heald RJ, Moran BJ (2001) Stoma-related complications are more frequent after transverse colostomy than loop ileostomy: a prospective randomized clinical trial. Br J Surg 88:360–363

    Article  CAS  PubMed  Google Scholar 

  5. Rullier E, Le Toux N, Laurent C, Garrelon JL, Parneix M, Saric J (2001) Loop ileostomy versus loop colostomy for defunctioning low anastomoses during rectal cancer surgery. World J Surg 25:274–277

    Article  CAS  PubMed  Google Scholar 

  6. Rondelli F, Reboldi P, Rulli A et al (2009) Loop ileostomy versus loop colostomy for fecal diversion after colorectal or coloanal anastomosis: a meta-analysis. Int J Colorectal Dis 24:479–488

    Article  CAS  PubMed  Google Scholar 

  7. Garcia-Botello SA, Garcia-Armengol J, Garcia-Granero E et al (2004) A prospective audit of the complications of loop ileostomy construction and takedown. Dig Surg 21:440–446

    Article  CAS  PubMed  Google Scholar 

  8. Gessler B, Haglind E, Angenete E (2012) Loop ileostomies in colorectal cancer patients—morbidity and risk factors for nonreversal. J Surg Res 178(2):708–714

    Article  PubMed  Google Scholar 

  9. Banerjee A (1997) Purse-string skin closure after stoma reversal. Dis Colon Rectum 40:993–994

    Article  CAS  PubMed  Google Scholar 

  10. Lee JR, Kim YW, Sung JJ, Song OP, Kim HC, Lim CW, Cho GS, Jung JC, Shin EJ (2011) Conventional linear versus purse-string skin closure after loop ileostomy reversal: comparison of wound infection rates and operative outcomes. J Korean Soc Coloproctol 27(2):58–63

    Article  PubMed Central  PubMed  Google Scholar 

  11. Sutton CD, Williams N, Marshall LJ, Lloyd G, Thomas WM (2002) A technique for wound closure that minimizes sepsis after stoma closure. ANZ J Surg 72:766–767

    Article  PubMed  Google Scholar 

  12. Reid K, Pockney P, Pollitt T, Draganic B, Smith SR (2010) Randomized clinical trial of short-term outcomes following purse-string versus conventional closure of ileostomy wounds. Br J Surg 97:1511–1517

    Article  CAS  PubMed  Google Scholar 

  13. Camacho-Mauries D, Rodriguez-Díaz JL, Salgado-Nesme N, González QH, Vergara-Fernández O (2013) Randomized clinical trial of intestinal ostomy takedown comparing purse string wound closure vs conventional closure to eliminate the risk of wound infection. Dis Colon Rectum 56(2):205–211

    Article  PubMed  Google Scholar 

  14. Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196

    Article  PubMed  Google Scholar 

  15. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 13:606–608

    Article  CAS  PubMed  Google Scholar 

  16. Oberkofler CE, Rickenbacher A, Raptis DA et al (2012) A multicenter randomized clinical trial of primary anastomosis or Hartmann’s procedure for perforated left colonic diverticulitis with purulent or fecal peritonitis. Ann Surg 256(5):861–868, discussion 868-9

    Article  PubMed  Google Scholar 

  17. Kaidar-Person O, Person B, Wexner SD (2005) Complications of construction and closure of temporary loop ileostomy. J Am Coll Surg 201:759–773

    Article  PubMed  Google Scholar 

  18. Chow A, Tilney HS, Paraskeva P, Jeyarajah S, Zacharakis E, Purkayastha S (2009) The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int J Colorectal Dis 24:711–723

    Article  PubMed  Google Scholar 

  19. Luglio G, Pendlimari R, Holubar SD, Cima RR, Nelson H (2011) Loop ileostomy reversal after colon and rectal surgery: a single institutional 5-year experience in 944 patients. Arch Surg 146(10):1191–1196

    Article  PubMed  Google Scholar 

  20. Mileski WJ, Rege RV, Joehl RJ, Nahrwold DL (1990) Rates of morbidity and mortality after closure of loop and end colostomy. Surg Gynecol Obstet 171:17–21

    CAS  PubMed  Google Scholar 

  21. Davis SS Jr, Husain FA, Lin E, Nandipati KC, Perez S, Sweeney JF (2013) Resident participation in index laparoscopic general surgical cases: impact of the learning environment on surgical outcome. J Am Coll Surg 216(1):96–104

    Article  PubMed  Google Scholar 

  22. Papandria D, Rhee D, Ortega G, Zhang Y, Gorgy A, Makary MA, Abdullah F (2012) Assessing trainee impact on operative time for common general surgical procedures in ACS-NSQIP. J Surg Educ 69(2):149–155

    Article  PubMed  Google Scholar 

  23. Milanchi S, Nasseri Y, Kidner T, Fleshner P (2009) Wound infection after ileostomy closure can be eliminated by circumferential subcuticular wound approximation. Dis Colon Rectum 52(3):469–474

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General and Visceral Surgery, Hospital of the Johann Wolfgang Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany

    Nils Habbe, Sabine Hannes, Juliane Liese, Guido Woeste, Wolf Otto Bechstein & Christoph Strey

  2. Department of General, Visceral and Vascular Surgery, Diakonie Krankenhaus Friederikenstift, Hannover, Germany

    Christoph Strey

Authors
  1. Nils Habbe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sabine Hannes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Juliane Liese
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Guido Woeste
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wolf Otto Bechstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christoph Strey
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nils Habbe.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Habbe, N., Hannes, S., Liese, J. et al. The use of purse-string skin closure in loop ileostomy reversals leads to lower wound infection rates—a single high-volume centre experience. Int J Colorectal Dis 29, 709–714 (2014). https://doi.org/10.1007/s00384-013-1822-6

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-013-1822-6

Keywords

Search

Navigation