title: Cosmetic and functional outcome after stoma site skin closure in children.
abstract: OBJECTIVE
  To evaluate the functional and cosmetic outcome of stoma closure in children after straight closure (SC) versus purse-string closure (PSC).
  
  
  METHODS
  The patients (n = 33, age 16-159 months), operated at a median age of 6 months (1-121 months) between 2007 and 2009 in our hospital, were studied to evaluate whether the proposed superiority of the PSC technique is applicable in children. The patients were operated with SC or PSC. The most common causes of the temporary stomas were necrotizing enterocolitis, Hirschsprung's disease and anal atresia. A validated scoring-system questionnaire (patient and observer scar assessment scale),POSAS was sent to the parents containing questions concerning pain, itchiness, colour, stiffness, thickness and irregularity of the scar completed by a visual analogue scale to evaluate an overall opinion.
  
  
  RESULTS
  25 families (SC; n = 12, PSC;n = 13) participated. The differences between the two groups are largest, although not statistically significant, for discoloration, stiffness, thickness and irregularity, with better scores in the PSC group. There was a better total POSAS score in the PSC group whilst the VAS shows very modest differences.
  
  
  CONCLUSIONS
  Our study indicates advantages of the PSC technique after stoma closure with better cosmetic and functional outcome. To be able to show statistically significant differences between PSC and SC a larger study would be useful.
authors.affiliation: Division of Pediatric Surgery, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden. lisaortqvist@gmail.com
authors.forename: Lisa
authors.initials: L
authors.lastname: Ortqvist
authors.forename: Markus
authors.initials: M
authors.lastname: Almström
authors.forename: Maria
authors.initials: M
authors.lastname: Ojmyr-Joelsson
authors.forename: Helena
authors.initials: H
authors.lastname: Wigander
authors.forename: Agneta
authors.initials: A
authors.lastname: Währner
authors.forename: Tomas
authors.initials: T
authors.lastname: Wester
mesh_terms: D001006:Anus, Imperforate / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000209:etiology / Q000473:pathology*; D020345:Enterocolitis, Necrotizing / Q000601:surgery; D004766:Enterostomy / Q000009:adverse effects / Q000379:methods*; D006627:Hirschsprung Disease / Q000601:surgery; D006801:Humans; D007223:Infant; D013536:Suture Techniques; D016896:Treatment Outcome; D014945:Wound Healing