title: Influence of skin closure technique on surgical site infection after loop ileostomy reversal: retrospective cohort study.
abstract: BACKGROUND
  Intestinal stoma closure is associated with high risk of surgical site infection (SSI) at stoma reversal site. The aim of this retrospective cohort study was to determine the outcome of purse string approximation (PSA) compared to primary linear closure (PLC) of the skin after loop ileostomy reversal.
  
  
  METHODS
  Data of 140 patients operated between 2005 and 2012 were analyzed in this two-center-study to determine the outcome of patients with either PSA (n = 44) or PLC (n = 96) after loop ileostomy reversal.
  
  
  RESULTS
  Patients in the PSA group were significantly older than in the PLC group (64 ± 15 vs. 57 ± 18; p = 0.026). Cardiac diseases were significantly more present in the PSA group in comparison to the PLC group (59% vs. 38%; p = 0.017). Stoma creation was significantly more often due to malignancy in the PSA group in comparison to the PLC group (68% vs. 50%; p = 0.044). SSI occurred significantly more often in the PLC group in comparison to the PSA group (17% vs. 5%; p = 0.047).
  
  
  CONCLUSIONS
  The risk for SSI is lower in patients with PSA in comparison to patients with PLC. In order to diminish SSI we recommend performing a PSA in patients with loop ileostomy reversal.
authors.affiliation: Department of General, Visceral and Transplant Surgery, RWTH Aachen University Hospital, Germany. Electronic address: cklink@ukaachen.de.
authors.forename: C D
authors.initials: CD
authors.lastname: Klink
authors.forename: M
authors.initials: M
authors.lastname: Wünschmann
authors.forename: M
authors.initials: M
authors.lastname: Binnebösel
authors.forename: H P
authors.initials: HP
authors.lastname: Alizai
authors.forename: A
authors.initials: A
authors.lastname: Lambertz
authors.forename: G
authors.initials: G
authors.lastname: Boehm
authors.forename: U P
authors.initials: UP
authors.lastname: Neumann
authors.forename: C J
authors.initials: CJ
authors.lastname: Krones
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D062109:Dermatologic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology*; D058106:Wound Closure Techniques / Q000009:adverse effects* / Q000706:statistics & numerical data*
keywords: Loop ileostomy; Primary linear closure; Purse string approximation; Skin closure; Surgical site infection