Annals of Coloproctology

Original Articles

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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19 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

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

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15 Web of Science
14 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

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
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

Effectiveness of Sodium Picosulfate/Magnesium Citrate (PICO) for Colonoscopy Preparation: Ki Hwan Song, Wu Seok Suh, Jin Sik Jeong, Dong Sik Kim, Sang Woo Kim, Dong Min Kwak, Jong Seong Hwang, Hyun Jin Kim, Man Woo Park, Min Chul Shim, Ja-Il Koo, Jae Hwang Kim, Dae Ho Shon; Ann Coloproctol. 2014;30(5):222-227. Published online October 28, 2014; DOI: https://doi.org/10.3393/ac.2014.30.5.222

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8 Web of Science
6 Citations

Abstract PDF

Purpose

Bowel preparation with sodium phosphate was recently prohibited by the U.S. Food and Drug Administration. Polyethylene glycol (PEG) is safe and effective; however, it is difficult to drink. To identify an easy bowel preparation method for colonoscopy, we evaluated three different bowel preparation regimens regarding their efficacy and patient satisfaction.

Methods

In this randomized, comparative study, 892 patients who visited a secondary referral hospital for a colonoscopy between November 2012 and February 2013 were enrolled. Three regimens were evaluated: three packets of sodium picosulfate/magnesium citrate (PICO, group A), two packets of PICO with 1 L of PEG (PICO + PEG 1 L, group B), and two packets of PICO with 2 L of PEG (PICO + PEG 2 L, group C). A questionnaire survey regarding the patients' preference for the bowel preparation regimen and satisfaction was conducted before the colonoscopies. The quality of bowel cleansing was scored by the colonoscopists who used the Aronchick scoring scale and the Ottawa scale.

Results

The patients' satisfaction rate regarding the regimens were 72% in group A, 64% in group B, and 45.9% in group C. Nausea and abdominal bloating caused by the regimens were more frequent in group C than in group A or group B (P < 0.01). Group C showed the lowest preference rate compared to the other groups (P < 0.01). Group C showed better right colon cleansing efficacy than group A or group B.

Conclusion

Group A exhibited a better result than group B or group C in patient satisfaction and preference. In the cleansing quality, no difference was noted between groups A and C.

Citations

Citations to this article as recorded by

White Diet with split‐dose Picosalax is preferred, better tolerated, and non‐inferior to day‐before clear fluids with polyethylene glycol plus sodium picosulfate‐magnesium citrate for morning colonoscopy: A randomized, non‐inferiority trial
Jeremy P Dwyer, Jonathan Y C Tan, Eldho Paul, Catherine Bunn, Dileep Mangira, Robyn Secomb, Peter R Gibson, Gregor Brown
JGH Open.2017; 1(1): 38. CrossRef
Randomized clinical trial comparing fixed-time split dosing and split dosing of oral Picosulfate regimen for bowel preparation
Jae Hyuck Jun, Koon Hee Han, Jong Kyu Park, Hyun Il Seo, Young Don Kim, Sang Jin Lee, Baek Gyu Jun, Min Sik Hwang, Yoon Kyoo Park, Myeong Jong Kim, Gab Jin Cheon
World Journal of Gastroenterology.2017; 23(32): 5986. CrossRef
Upper airway obstruction resulting from acute mucosal injury induced by direct ingestion of sodium picosulfate/magnesium citrate powder
Gyeong Bo Kim, Sung Yeon Hwang, Tae Gun Shin, Tae Rim Lee, Won Chul Cha, Min Seob Sim, Ik Joon Jo, Keun Jeong Song, Joong Eui Rhee, Yeon Kwon Jeong
Clinical and Experimental Emergency Medicine.2016; 3(2): 109. CrossRef
Combination could be another tool for bowel preparation?
Jae Seung Soh, Kyung-Jo Kim
World Journal of Gastroenterology.2016; 22(10): 2915. CrossRef
Phase II Randomized Controlled Trial of Combined Oral laxatives Medication for BOwel PREParation (COMBO-PREP study)
Min Jung Kim, Chang Won Hong, Byung Chang Kim, Sung Chan Park, Kyung Su Han, Jungnam Joo, Jae Hwan Oh, Dae Kyung Sohn
Medicine.2016; 95(7): e2824. CrossRef
Frustration Still Exists
Hyun Shig Kim
Annals of Coloproctology.2014; 30(5): 207. CrossRef

A Survey II for Satisfaction for Stoma on Ostomates.: Kim, Joon Ho , Lee, Seok Hwan , Ko, Young Gwan , Oh, Soo Myung , Yoon, Choong , Joo, Hoong Zae , Lee, Kee Hyung; J Korean Soc Coloproctol. 1999;15(1):31-35.

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Abstract PDF: PURPOSE
This survey was designed to acknowledge that it is necessary to rehabilitate ostomates.
METHODS
This medical survey attempted to make an analysis of the types and causes of stoma, the problems stemming from the stoma, the degree to which ostomates are satisfied with their life quality, and the extent to which they are affected in doing their jobs, on the basis of the examinations conducted for eighty eight ostomates, who responded to the questionnaire at the 3rd Workshop for Stoma Rehabilitation for Ostomates on August 29, 1998 by the Department of Surgery, Kyung-Hee University Hospital, or who replied back to the questionnaire that was sent by mail.
RESULTS
On examination, it was found that the ratio of male to female was nearly 1.5:1 (53:35); by age distribution, the ostomates in their 50 and 60's constituted 65.9%; by stoma pattern, colostomy was made up of 81 cases (92%), ileostomy 4 cases (4.5%), urostomy 2 cases (2.3%); by duration, permanent stoma was 81 cases (92%), temporary stoma 6 cases (6.8%); by the cause of stoma operation, malignancy consisted of 78 cases (88.6%), IBD 4 cases (4.5%), congenital anomaly 1 case, car accident 1 case, benign bladder disease 1 case, intestinal obstruction after radiation therapy 1 case, but 2 cases were not identified. Besides, it was also examined that, regarding the degree of post-operation satisfaction for stoma, dissatisfaction amounted to 58 cases (65.9%); as for the problems stemming from the stoma, skin irritation or injury reached 30 cases (34.1%), discomfort for stoma location 17 cases (19.35%), parastomal hernia 8 cases (9.1%), stoma retraction 4 cases (4.5%) and disease recurrence 3 cases (3.4%); as for the degree of the satisfaction of ostomates for their life quality, dissatisfaction revealed 70 cases (79.5%); regarding the extent to which the ostomates are affected in doing their jobs, fifty four out of eighty eight ostomates (62.0%) had a disturbance.
CONCLUSIONS
This medical survey clearly shows that most of ostomates suffered from stoma in their daily lives and doing their occupations, thus they need helps from the experts such as colorectal surgeons and enterostomal therapists, or the ostomy association. In addition, it is also necessary to pay a more deliberate attention to determining the location of stoma.

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