A prospective study of 'circumferential purse-string approximation' vs. primary linear skin closure in stoma reversal

Manavdeep Singh Bains; Amandeep Singh Nar; Harmandeep Singh Jabbal; Atul Mishra; Akashi Mishra; Priyanka Sharma

doi:10.11604/pamj.2022.42.287.29213

A prospective study of 'circumferential purse-string approximation' vs. primary linear skin closure in stoma reversal

Pan Afr Med J. 2022 Aug 17:42:287. doi: 10.11604/pamj.2022.42.287.29213. eCollection 2022.

Authors

Manavdeep Singh Bains¹, Amandeep Singh Nar², Harmandeep Singh Jabbal³, Atul Mishra², Akashi Mishra⁴, Priyanka Sharma⁵

Affiliations

¹ Bains General and Surgical Hospital, Nawanshahar, Punjab, India.
² Department of General Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
³ Department of General Surgery, All India Institute of Medical Sciences, Bathinda, Punjab, India.
⁴ Himalayan Institute of Medical Sciences, Jolly Grant, Dehradun, Uttrakhand, India.
⁵ Department of Pathology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India.

Abstract

Introduction: surgical site infection (SSI) is one of the most common complications that can occur after stoma closure. To date, there is no consensus on the ideal closure technique of the stoma wound to minimize postoperative SSI and multiple techniques have been proposed. We performed this study to assess the clinical outcome of wound healing after 'Primary Linear Closure' (PC) and 'Circumferential Purse-String Approximation' (CPA) techniques.

Methods: this prospective observational study included all patients admitted to our tertiary care center, fulfilling the inclusion criteria for elective stoma closure from 1^st March 2018 to 1 March 2020 and prospective study was conducted on wound healing after stoma closure to compare difference in SSI rate between the PC group and the CPA group and to discuss the differences in patient satisfaction with wound healing. The following study was carried out with 36 patients in purse-string group and 66 patients in linear closure group.

Results: surgical site infection (SSI) was observed only in primary linear closure group in 24% patients as opposed to 0% in purse string closure group. (p=0.039). Although the mean healing time of wound in linear closure group was significantly less than the purse string group (10.76 ± 5.68 days and 14.17 ± 2.04 days respectively), the overall total satisfaction score was higher in the purse string group. The purse string closure group showed significantly higher satisfaction score for expectations regarding appearance of scar/cosmesis, level of postoperative pain and difficulty of wound care (p>0.05).

Conclusion: in our study, 'Circumferential Purse-String Approximation' is a superior technique than Primary Linear Closure for Stoma reversal in terms of rate of SSI and better overall patient satisfaction. CPA is a good alternative option, but further prospective randomized trials involving more patients are necessary before a definitive conclusion can be drawn.

Keywords: Stoma; circumferential purse-string approximation; closure; primary linear closure; reversal; surgical site infection; technique.

Copyright: Manavdeep Singh Bains et al.

Publication types

Observational Study

MeSH terms

Humans
Margins of Excision
Prospective Studies
Skin
Surgical Stomas*
Surgical Wound Infection* / epidemiology
Surgical Wound Infection* / etiology
Surgical Wound Infection* / prevention & control
Wound Closure Techniques / adverse effects