Annals of Coloproctology

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Purse-String Versus Linear Conventional Skin Wound Closure of an Ileostomy: A Randomized Clinical Trial: Mina Alvandipour, Babak Gharedaghi, Hamed Khodabakhsh, Mohammad Yasin Karami; Ann Coloproctol. 2016;32(4):144-149. Published online August 31, 2016; DOI: https://doi.org/10.3393/ac.2016.32.4.144

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28 Citations

Purpose

Infection is one of the most frequent complications that can occur after ileostomy closure. The incidence of wound infection depends on the skin closure technique, but there is no agreement on the perfect closure method for an ileostomy wound. The aim of this study was to evaluate the incidence of infection, the patient's approval, and the patient's pain between purse-string closure (PSC) and the usual linear closure (LC) of a stoma wound.

Methods

This randomized clinical trial enrolled 66 patients who underwent a stoma closure from February 2015 to May 2015 in Sari Emam Khomeini Hospital. Patients were divided into 2 groups according to the stoma closing method: the PSC group (n = 34) and the LC group (n = 32). The incidences of infection for the 2 groups were compared, and the patients' satisfaction and pain with the stoma were determined by using a questionnaire.

Results

Infection occurred in 1 of 34 PSC patients (2.9%) and in 7 of 32 LC patients (21.8%), and this difference was statistically significant (P = 0.021). Patients in the PSC group were more satisfied with the resulting wound scar and its cosmetic appearance at one month and three months after surgery (P = 0.043).

Conclusion

After stoma closure, PSC was associated with a significantly lower incidence of wound infection and greater patient satisfaction compared to LC. However, the healing period for patients who underwent PSC was longer than it was for those who underwent LC.

Citations

Citations to this article as recorded by

Gunsight closure versus conventional techniques for reversal of protective stoma after rectal cancer surgery: a propensity score matching study
Senbin Lin, Misha Mao, Rui Chen, Linnan Guo, Mengya Zhou, Jianhui Chen
International Journal of Colorectal Disease.2026;[Epub] CrossRef
A systematic review and Bayesian network meta‐analysis of randomized controlled trials on multiple skin closure techniques following stoma closure
Daichi Kitaguchi, Antonello Forgione, Chiara Innocenzi, Yuchuan Yang, Federico Espínola, Mariano Giménez, Tatsuya Oda, Jacques Marescaux
Colorectal Disease.2026;[Epub] CrossRef
Primary Linear Closure With Negative Pressure Wound Therapy Versus Purse-String Approximation After Ileostomy Reversal: A Randomized Noninferiority Trial
Devesh S. Ballal, Daniel J. Borsuk, Mark Gabriel C. Gonzalez, Marhama Zafar, Slawomir J. Marecik, John J. Park, Gerald Gantt, Kunal Kochar
Diseases of the Colon & Rectum.2026; 69(7): 1921. CrossRef
Comparison of Efficacy Between Linear Versus Purse String Skin Closure at Loop Ileostomy Reversal
Naseeb Ali, Shahid Munir, Gohar Ali, Muhammad Kashif Dawar, Muhammad Bilal, Muhammad shah, Muhammad Ayub
Journal of Gandhara Medical and Dental Science.2026; 13(3): 47. CrossRef
Mechanically powered negative pressure dressing reduces surgical site infection after stoma reversal
Brian Williams, Aubrey Swinford, Jordan Martucci, Johnny Wang, Jordan R. Wlodarczyk, Abhinav Gupta, Kyle G. Cologne, Sarah E. Koller, Christine Hsieh, Marjun P. Duldulao, Joongho Shin
Surgery Open Science.2025; 23: 69. CrossRef
Usefulness of a negative pressure wound therapy system for stoma closure
Chisato Shirakawa, Yuzuru Sakamoto, Shinya Ueki, Hiroki Shomura, Keizo Kazui, Akinobu Taketomi
Journal of Wound Care.2025; 34(2): 106. CrossRef
Circular (purse-string) vs primary skin closure following stoma closure: an up-to-date systematic review and meta-analysis
F. Menegon Tasselli, F. Pata, G. Fuschillo, G. Signoriello, A. Bondurri, G. Sciaudone, F. Selvaggi, G. Pellino
Techniques in Coloproctology.2025;[Epub] CrossRef
Primary closure of ileostomy site after irrigation with betaine–polyhexanide: a case series
Henry Krasner, Abigail W Cheng, Lance Horner, Ovunc Bardakcioglu
Journal of Surgical Case Reports.2025;[Epub] CrossRef
Comparison of purse-string technique versus linear suture for skin closure after stoma reversal: a meta-analysis of high-quality studies
Filippo Carannante, Guglielmo Niccolò Piozzi, Gianluca Costa, Valentina Miacci, Gianfranco Bianco, Vincenzo Schiavone, Jim S. Khan, Marco Caricato, Gabriella Teresa Capolupo
Annals of Coloproctology.2025; 41(6): 491. CrossRef
The Outcome of Purse-string Versus Conventional Wound Closure Techniques in Patients Undergoing Stoma Reversal: A Randomized Controlled Trial
Assad Ameer, Muhammad Bilal Mirza, Nabila Talat
Journal of Pediatric Surgery.2024; 59(6): 1186. CrossRef
Purse-string skin closure versus linear skin closure in people undergoing stoma reversal
Shahab Hajibandeh, Shahin Hajibandeh, Andrew Maw
Cochrane Database of Systematic Reviews.2024;[Epub] CrossRef
Comparison of purse-string technique vs linear suture for skin closure after ileostomy reversal. A randomized controlled trial
Filippo Carannante, Gianluca Costa, Valentina Miacci, Gianfranco Bianco, Gianluca Masciana, Sara Lauricella, Marco Caricato, Gabriella Teresa Capolupo
Langenbeck's Archives of Surgery.2024;[Epub] CrossRef
Purse-string versus linear closure of the skin wound following stoma reversal: A meta-analysis with RCT and systematic review
Jinlong Luo, Dan Liu, Junmei Wu, Huaiwu Jiang, Jin Chen, Hua Yang, Lie Yang
Medicine.2024; 103(35): e39477. CrossRef
Short-term outcomes following purse-string versus conventional closure of ileostomy wounds in Chinese colorectal cancer patients — a single center retrospective study
Yu-Rong Jiao, Xin-Bin Zhou, Yao Ye, Qian Xiao, Xiang-Xing Kong, Ke-Feng Ding, Jun Li
Holistic Integrative Oncology.2023;[Epub] CrossRef
Results of application of the technique of the extraperitoneal closure of loop intestinal stoma
N. A. Maistrenko, A. A. Sazonov, P. N. Romashchenko, M. V. Zotov
Grekov's Bulletin of Surgery.2023; 181(6): 64. CrossRef
Wound Infection After Ileostomy Closure: An Interim Analysis of a Prospective Randomized Study Comparing Primary Versus Circumferential Subcuticular Closure Techniques
Sumesh Kaistha, Rajesh Panwar, Sujoy Pal, Nihar Ranjan Dash, Peush Sahni, Tushar Kanti Chattopadhyay
Surgical Infections.2023; 24(9): 797. CrossRef
Purse-string skin closure versus linear skin closure in people undergoing stoma reversal
Shahab Hajibandeh, Shahin Hajibandeh, Andrew Maw
Cochrane Database of Systematic Reviews.2022;[Epub] CrossRef
COMPARISON BETWEEN OSTOMY CLOSURE USING PURSE-STRING VERSUS LINEAR IN CHILDREN
Shahnam Askarpour, Mehran Peyvasteh, Farbod Farhadi, Hazhir Javaherizadeh
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo).2022;[Epub] CrossRef
Negative-pressure wound therapy after stoma reversal in colorectal surgery: a randomized controlled trial
Francesco M Carrano, Annalisa Maroli, Michele Carvello, Caterina Foppa, Matteo Sacchi, Jacopo Crippa, Giuseppe Clerico, Francesca De Lucia, Elisabetta Coppola, Nadav Ben David, Antonino Spinelli
BJS Open.2021;[Epub] CrossRef
Evidence-based adoption of purse-string skin closure for stoma wounds
Nilotpal Behuria, Jayant Kumar Banerjee, Sita Ram Ghosh, Shrirang Vasant Kulkarni, Ramanathan Saranga Bharathi
Medical Journal Armed Forces India.2020; 76(2): 185. CrossRef
Gunsight Procedure Versus the Purse-String Procedure for Closing Wounds After Stoma Reversal: A Multicenter Prospective Randomized Trial
Jia Gang Han, Hong Wei Yao, Jian Ping Zhou, Hong Zhang, Gui Ying Wang, Zhan Long Shen, Jian Feng Gong, Zhen Jun Wang
Diseases of the Colon & Rectum.2020; 63(10): 1411. CrossRef
Quality of life following ostomy reversal with purse-string vs linear skin closure: a systematic review
Emanuele Rausa, M. E. Kelly, G. Sgroi, V. Lazzari, A. Aiolfi, F. Cavalcoli, G. Bonitta, L. Bonavina
International Journal of Colorectal Disease.2019; 34(2): 209. CrossRef
Purse-string vs. linear skin closure at loop ileostomy reversal: a systematic review and meta-analysis
M. Gachabayov, H. Lee, A. Chudner, A. Dyatlov, N. Zhang, R. Bergamaschi
Techniques in Coloproctology.2019; 23(3): 207. CrossRef
Italian guidelines for the surgical management of enteral stomas in adults
F. Ferrara, D. Parini, A. Bondurri, M. Veltri, M. Barbierato, F. Pata, F. Cattaneo, A. Tafuri, C. Forni, G. Roveron, G. Rizzo
Techniques in Coloproctology.2019; 23(11): 1037. CrossRef
Purse-string closure versus conventional primary closure of wound following stoma reversal: Meta-analysis of randomized controlled trials
Fabio Rondelli, Laura Franco, Ruben Carlo Balzarotti Canger, Graziano Ceccarelli, Cecilia Becattini, Walter Bugiantella
International Journal of Surgery.2018; 52: 208. CrossRef
Purse-string skin closure versus linear skin closure techniques in stoma closure: a comprehensive meta-analysis with trial sequential analysis of randomised trials
Shahab Hajibandeh, Shahin Hajibandeh, Andrew Kennedy-Dalby, Sheik Rehman, Reza Arsalani Zadeh
International Journal of Colorectal Disease.2018; 33(10): 1319. CrossRef
LOOP ILEOSTOMY CLOSURE (review)
I. S. Lantsov, A. I. Moskalev, O. I. Sushkov
Koloproktologia.2018; (2): 102. CrossRef
The effect of purse-string approximation versus linear approximation of ileostomy reversal wounds on morbidity rates and patient satisfaction: the 'STOMA' trial
D. P. O’Leary, M. Carter, D. Wijewardene, M. Burton, D. Waldron, E. Condon, J. C. Coffey, C. Peirce
Techniques in Coloproctology.2017; 21(11): 863. CrossRef

Clinical Trial on the Incidence of Wound Infection and Patient Satisfaction After Stoma Closure: Comparison of Two Skin Closure Techniques: Sang Il Yoon, Sun Mi Bae, Hwan Namgung, Dong Guk Park; Ann Coloproctol. 2015;31(1):29-33. Published online February 28, 2015; DOI: https://doi.org/10.3393/ac.2015.31.1.29

9,293 View
75 Download
23 Web of Science
21 Citations

Abstract PDF

Purpose

Surgical site infection (SSI) is one of the most common complications that can occur after stoma closure. Reports have described differences in the incidence of wound infection depending on the skin closure technique, but there is no consensus on the ideal closure technique for a stoma wound. The aim of this study was to compare the incidence of SSI and the patient satisfaction between a circumferential purse-string approximation (CPA) and a primary linear closure (PC) of a stoma wound.

Methods

This prospective nonrandomized trial enrolled 48 patients who underwent a stoma closure from February 2010 to October 2013. Patients were divided into two groups according to the stoma closing technique: the CPA group (n = 34) and the PC group (n = 14). The incidences of SSI for the two groups were compared, and the patients' satisfaction with the stoma closure was determined by using a questionnaire.

Results

SSI occurred in 3 of 48 patients (6.3%) and was more frequent in the PC group than in the CPA group (3/14 [21.4%] vs. 0/34 [0%], P = 0.021). Time to complete healing after stoma closure in the CPA group was 32 days (range, 14-61 days). Patients in the CPA group were more satisfied with the resulting wound scar (P = 0.043).

Conclusion

After stoma closure, CPA was associated with a significantly lower incidence of wound infection and greater patient satisfaction compared to PC. However, with the CPA technique, the time to heal is longer than it is with PC.

Citations

Citations to this article as recorded by

Primary Linear Closure With Negative Pressure Wound Therapy Versus Purse-String Approximation After Ileostomy Reversal: A Randomized Noninferiority Trial
Devesh S. Ballal, Daniel J. Borsuk, Mark Gabriel C. Gonzalez, Marhama Zafar, Slawomir J. Marecik, John J. Park, Gerald Gantt, Kunal Kochar
Diseases of the Colon & Rectum.2026; 69(7): 1921. CrossRef
First Experience with the NPseal®: A Novel Mechanically Powered Negative Pressure Dressing Applied to Colorectal Surgery Wounds
Johnny Wang, Brian Williams, Jordan R. Wlodarczyk, Abhinav Gupta, Debora Kim, Kyle G. Cologne, Sarah E. Koller, Christine Hsieh, Marjun P. Duldulao, Joongho Shin
Surgical Innovation.2025; 32(2): 127. CrossRef
Mechanically powered negative pressure dressing reduces surgical site infection after stoma reversal
Brian Williams, Aubrey Swinford, Jordan Martucci, Johnny Wang, Jordan R. Wlodarczyk, Abhinav Gupta, Kyle G. Cologne, Sarah E. Koller, Christine Hsieh, Marjun P. Duldulao, Joongho Shin
Surgery Open Science.2025; 23: 69. CrossRef
Comparison of Negative Pressure Wound Therapy Systems and Conventional Non-Pressure Dressings on Surgical Site Infection Rate After Stoma Reversal: Systematic Review and Meta-Analysis of Randomized Controlled Trials
Elissavet Anestiadou, Stavros Stamiris, Orestis Ioannidis, Savvas Symeonidis, Stefanos Bitsianis, Konstantinos Bougioukas, Thomas Karagiannis, Efstathios Kotidis, Manousos-Georgios Pramateftakis, Ioannis Mantzoros, Angeliki Cheva, Georgios Geropoulos, Chr
Journal of Clinical Medicine.2025; 14(5): 1654. CrossRef
Impact of different skin suturing methods on patient prognosis after ileostomy closure
Yu-Bo Gao, Liang Wang, Li-Na Shi, Xiao Wu, Wei Miao
World Journal of Gastrointestinal Surgery.2025;[Epub] CrossRef
Comparison of purse-string technique versus linear suture for skin closure after stoma reversal: a meta-analysis of high-quality studies
Filippo Carannante, Guglielmo Niccolò Piozzi, Gianluca Costa, Valentina Miacci, Gianfranco Bianco, Vincenzo Schiavone, Jim S. Khan, Marco Caricato, Gabriella Teresa Capolupo
Annals of Coloproctology.2025; 41(6): 491. CrossRef
Clinical Benefits of Reducing Dead Space Using a Closed Suction Drain and Subcutaneous Large-bite Buried Suture Technique to Prevent Superficial Surgical-site Infections Following Primary Closure of a Diverting Stoma
Yusuke Ohara, Yohei Owada, Jaejeong Kim, Shoko Moue, Yoshimasa Akashi, Koichi Ogawa, Kazuhiro Takahashi, Osamu Shimomura, Kinji Furuya, Shinji Hashimoto, Tsuyoshi Enomoto, Tatsuya Oda
Journal of the Anus, Rectum and Colon.2024; 8(2): 70. CrossRef
Comparison of purse-string technique vs linear suture for skin closure after ileostomy reversal. A randomized controlled trial
Filippo Carannante, Gianluca Costa, Valentina Miacci, Gianfranco Bianco, Gianluca Masciana, Sara Lauricella, Marco Caricato, Gabriella Teresa Capolupo
Langenbeck's Archives of Surgery.2024;[Epub] CrossRef
Purse-string versus linear closure of the skin wound following stoma reversal: A meta-analysis with RCT and systematic review
Jinlong Luo, Dan Liu, Junmei Wu, Huaiwu Jiang, Jin Chen, Hua Yang, Lie Yang
Medicine.2024; 103(35): e39477. CrossRef
Gunsight suture with subcutaneous vacuum drainage during enterostomy decreased the surgical site infection rate in obese rectal cancer patients: A retrospective study
Lei Zhang, Zhi-Qiang Xiao, Chang-Ling San, Tong-Lin Miao
Journal of Nutritional Oncology.2023; 8(3): 151. CrossRef
Effectiveness of negative pressure wound therapy with instillation and dwelling after stoma closure: a retrospective and propensity score matching analysis
Yoshinori Yane, Jin-ichi Hida, Yasutaka Chiba, Yusuke Makutani, Hokuto Ushijima, Yasumasa Yoshioka, Masayoshi Iwamoto, Toshiaki Wada, Koji Daito, Tadao Tokoro, Kazuki Ueda, Junichiro Kawamura
Scientific Reports.2022;[Epub] CrossRef
The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for Ostomy Surgery
Bradley R. Davis, Michael A. Valente, Joel E. Goldberg, Amy L. Lightner, Daniel L. Feingold, Ian M. Paquette
Diseases of the Colon & Rectum.2022; 65(10): 1173. CrossRef
The technique for less infectious and earlier healing of stoma closure wound: negative pressure wound therapy with instillation and dwelling followed by primary closure
Yoshinori Yane, Jin-ichi Hida, Yusuke Makutani, Hokuto Ushijima, Yasumasa Yoshioka, Masayoshi Iwamoto, Toshiaki Wada, Koji Daito, Tadao Tokoro, Kazuki Ueda, Junichiro Kawamura
BMC Surgery.2021;[Epub] CrossRef
Symptoms and Care Satisfaction in Patients Who Underwent Coronary Artery Bypass Graft Surgery
Tuğçe BOZKURT
Clinical and Experimental Health Sciences.2021; 11(3): 481. CrossRef
Evidence-based adoption of purse-string skin closure for stoma wounds
Nilotpal Behuria, Jayant Kumar Banerjee, Sita Ram Ghosh, Shrirang Vasant Kulkarni, Ramanathan Saranga Bharathi
Medical Journal Armed Forces India.2020; 76(2): 185. CrossRef
Gunsight Procedure Versus the Purse-String Procedure for Closing Wounds After Stoma Reversal: A Multicenter Prospective Randomized Trial
Jia Gang Han, Hong Wei Yao, Jian Ping Zhou, Hong Zhang, Gui Ying Wang, Zhan Long Shen, Jian Feng Gong, Zhen Jun Wang
Diseases of the Colon & Rectum.2020; 63(10): 1411. CrossRef
Purse-string approximation vs. primary closure with a drain for stoma reversal surgery: results of a randomized clinical trial
Kunihiko Amamo, Hideyuki Ishida, Kensuke Kumamoto, Norimichi Okada, Satoshi Hatano, Noriyasu Chika, Yusuke Tajima, Tomonori Ohsawa, Masaru Yokoyama, Keiichiro Ishibashi, Erito Mochiki
Surgery Today.2019; 49(3): 231. CrossRef
Purse-string vs. linear skin closure at loop ileostomy reversal: a systematic review and meta-analysis
M. Gachabayov, H. Lee, A. Chudner, A. Dyatlov, N. Zhang, R. Bergamaschi
Techniques in Coloproctology.2019; 23(3): 207. CrossRef
Incisional hernia following closure of loop ileostomy: The main predictor is the patient, not the surgeon
A.J. Brook, S.D. Mansfield, I.R. Daniels, N.J. Smart
The Surgeon.2018; 16(1): 20. CrossRef
Purse-string skin closure versus linear skin closure techniques in stoma closure: a comprehensive meta-analysis with trial sequential analysis of randomised trials
Shahab Hajibandeh, Shahin Hajibandeh, Andrew Kennedy-Dalby, Sheik Rehman, Reza Arsalani Zadeh
International Journal of Colorectal Disease.2018; 33(10): 1319. CrossRef
Effect of a Purse-String Approximation Following Stoma Takedown on Wound Infection and Satisfaction
In Ja Park
Annals of Coloproctology.2015; 31(1): 7. CrossRef

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