Wound infection following stoma takedown: primary skin closure versus subcuticular purse-string suture.
BACKGROUND
Stoma closure has been associated with a high rate of surgical site infection (SSI) and the ideal stoma-site skin closure technique is still debated. The aim of this study was to compare the rate of SSI following primary skin closure (PC) versus a skin-approximating, subcuticular purse-string closure (APS).


METHODS
All consecutive patients undergoing stoma closure between 2002 and 2007 by two surgeons at a single tertiary-care institution were retrospectively assessed. Patients who had a new stoma created at the same site or those without wound closure were excluded. The end point was SSI, determined according to current CDC guidelines, at the stoma closure site and/or the midline laparotomy incision.


RESULTS
There were 61 patients in the PC group (surgeon A: 58 of 61) and 17 in the APS group (surgeon B: 16 of 17). The two groups were similar in baseline and intraoperative characteristics, except that patients in the PC group were more often diagnosed with benign disease (p = 0.0156) and more often had a stapled anastomosis (p = 0.002). The overall SSI rate was 14 of 78 (18%). All SSIs occurred in the PC group (14 of 61 vs. 0 of 17, p = 0.03).


CONCLUSIONS
Our study suggests that a skin-approximating closure with a subcuticular purse-string of the stoma site leads to less SSI than a primary closure. Randomized studies are needed to confirm our findings and assess additional end points such as healing time, cost, and patient satisfaction.
Marquez
Thao T
TT
Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, 420 Delaware Street SE, MMC 450, Minneapolis, MN 55455, USA. tran0360@umn.edu
Christoforidis
Dimitrios
D
Abraham
Anasooya
A
Madoff
Robert D
RD
Rothenberger
David A
DA
D000293:Adolescent; D000328:Adult; D000368:Aged; D062109:Dermatologic Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D054047:Surgical Stomas; D013530:Surgical Wound Infection / Q000209:etiology*; D013536:Suture Techniques; D055815:Young Adult