Wound infection after ileostomy closure: a prospective randomized study comparing primary vs. delayed primary closure techniques.
BACKGROUND
Closure of ileostomy is considered a contaminated operation. The infection rate of the stoma wound is > or = 30%. Several ileostomy-closure techniques intended to reduce the high rate of infection have been described in the literature. Among them, delayed primary closure of the stoma wound is a commonly used method that was reported to reduce the infection rate according to several retrospective studies. We therefore conducted the first prospective randomized trial comparing primary with delayed primary closure of a stoma wound.


METHODS
During 2003, 40 patients were admitted to our ward for closure of ileostomy. The ileostomies were taken down by the same team using the same surgical technique except for the technique of wound closure. We randomly divided the patients into two groups. In Group 1 (n = 20), the wound was left open for delayed primary closure and not closed until postoperative day 4. In Group 2, the wound was primarily closed at the end of the procedure.


RESULTS
The total wound infection rate was relatively low (15%). Infection occurred more frequently (4 cases, 20%) in Group 1 than in Group 2 (2 cases, 10%). The length of hospital stay was similar for both groups.


CONCLUSIONS
In this first prospective comparison of two techniques during ileostomy take down, primary closure unexpectedly produced less wound infection than delayed primary closure.
Lahat
G
G
Proctology Unit, Division of Surgery B, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Tulchinsky
H
H
Goldman
G
G
Klauzner
J M
JM
Rabau
M
M
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects* / Q000379:methods; D007082:Ileum / Q000601:surgery*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012016:Reference Values; D012086:Reoperation / Q000009:adverse effects* / Q000379:methods*; D018570:Risk Assessment; D017678:Sex Distribution; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology