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Title: Outcomes of Purse-string versus Conventional Linear Suture Closure of the Skin Wound Following Ileostomy Reversal
Authors: Muhammad Adnan Khokhar, Afaq Ahmad, Ibad Ur Rehman, Tashfeen Imtiaz, Erum Najeeb, Muhammad Burhan Ul Haq, Roohi Saghir
Journal: Journal of Islamabad Medical and Dental College (JIMDC)
Publisher: Healers Educational Society
Country: Pakistan
Year: 2024
Volume: 13
Issue: 1
Language: English
DOI: 10.35787/jimdc.v13i1.1114
Keywords: Purse string suturelinear sutureileostomy reversalintestinal stomasurgical site infectiondog ear deformity.
Objective: Intestinal stomas are made in a variety of settings and their reversal is also a routine surgery. Due to their clean contaminated nature, there is a high risk of surgical site infection post-operatively. The objective of this study is to determine the difference in outcomes in two different techniques of skin closure after stoma reversal
Methods: The study was conducted at department of general surgery, Pakistan Institute of Medical Sciences, Islamabad over a period of six months. Seventy-one patients who underwent ileostomy reversal surgery in an elective setting were assigned two groups randomly: 34 in Group A and 37 in Group B. The group A patients underwent purse string closure for stoma site skin wound whereas patients in group B underwent conventional linear closure. Time taken for surgery was noted and the patients were followed over one month period for development of any surgical site infection or dog-ear deformity.
Results: The incidence of surgical site infection was 8.8% in the purse string closure group compared to 43.2 % in the linear closure group. Seven patients in group B developed dog ear deformity whereas no such case was noted in Group A.
Conclusions: Purse string closure is an effective and applicable technique for the closure of skin wounds after stoma reversal surgery. It is comparatively better in terms of prevention of surgical site infection as well as dog ear deformity in the closure of skin wounds after ileostomy reversal.
Key words: Purse string suture, linear suture, ileostomy reversal, intestinal stoma, surgical site infection, dog ear deformity.
To determine the difference in outcomes between purse-string closure and conventional linear closure of the skin wound following ileostomy reversal surgery, specifically regarding surgical site infection and dog-ear deformity.
A randomized controlled study conducted at the Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad, over six months. Seventy-one patients undergoing elective ileostomy reversal were randomly assigned to two groups: Group A (34 patients) underwent purse-string closure, and Group B (37 patients) underwent conventional linear closure. Outcomes measured included surgical site infection (SSI), dog-ear deformity, operative time, time to diagnose SSI, length of hospital stay, and readmission rates. Data were analyzed using SPSS version 25, with chi-square/Fischer exact test for SSI incidence and t-test for continuous variables.
graph TD
A["Patient Selection for Ileostomy Reversal"] --> B["Random Assignment"];
B --> C["Group A: Purse-string Closure"];
B --> D["Group B: Linear Closure"];
C --> E["Follow-up 1 month"];
D --> E;
E --> F["Data Collection: SSI, Dog-ear, LOS, etc."];
F --> G["Data Analysis SPSS"];
G --> H["Comparison of Outcomes"];
H --> I["Conclusion"];
The purse-string closure technique is presented as a superior method for closing skin wounds after ileostomy reversal due to its significantly lower rates of surgical site infection and absence of dog-ear deformities. The technique's advantage is attributed to the smaller wound size, which facilitates drainage and leads to better scar cosmesis. The study's findings are supported by several international studies and meta-analyses. Limitations include a relatively small sample size, single-center design, and exclusion of colostomy closure cases.
The incidence of surgical site infection was significantly lower in the purse-string closure group (8.8%) compared to the linear closure group (43.2%) (p<0.01). Dog-ear deformity occurred in 18.91% of the linear closure group, with none in the purse-string group (p<0.001). The mean time to diagnose SSI was significantly shorter in the purse-string group (16.00 hours) than in the linear closure group (37.13 hours) (p<0.01). The mean length of hospital stay was also significantly shorter in the purse-string group (2.15 days) compared to the linear closure group (2.62 days) (p<0.01).
The purse-string suture technique is a more effective and applicable method for closing skin wounds after ileostomy reversal compared to linear closure, offering better outcomes in terms of preventing surgical site infections and dog-ear deformities, as well as improved cosmetic results. It is recommended as the preferred method for such procedures.
1. Surgical Site Infection Rate: The study reports an 8.8% SSI rate for purse-string closure versus 43.2% for linear closure. This is a statistically significant difference (p<0.01).
2. Dog-Ear Deformity: The study found no dog-ear deformities in the purse-string group, compared to 18.91% in the linear closure group (p<0.001).
3. Time to Diagnose SSI: The mean time to diagnose SSI was 16.00 hours for purse-string closure and 37.13 hours for linear closure (p<0.01).
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