title: Systematic review and meta-analysis of published randomized controlled trials comparing purse-string vs conventional linear closure of the wound following ileostomy (stoma) closure.
abstract: OBJECTIVE
  The objective of this article is to systematically analyse the randomized, controlled trials comparing the effectiveness of purse-string closure (PSC) of an ileostomy wound with conventional linear closure (CLC).
  
  
  METHODS
  Randomized, controlled trials comparing the effectiveness of purse-string closure vs conventional linear closure (CLC) of ileostomy wound in patients undergoing ileostomy closure were analysed using RevMan®, and the combined outcomes were expressed as risk ratio (RR) and standardized mean difference (SMD).
  
  
  RESULTS
  Three randomized, controlled trials, recruiting 206 patients, were retrieved from medical electronic databases. There were 105 patients in the PSC group and 101 patients in the CLC group. There was no heterogeneity among included trials. Duration of operation (SMD: -0.18; 95% CI: -0.45, 0.09; z = 1.28; P < 0.20) and length of hospital stay (SMD: 0.01; 95% CI: -0.26, 0.28; z = 0.07; P < 0.95) was statistically similar following both approaches of ileostomy wound closure. The risk of surgical site infection (OR, 0.10; 95% CI: 0.03, 0.33; z = 3.78; P < 0.0001) was significantly reduced when ileostomy wound was closed using PSC technique.
  
  
  CONCLUSIONS
  PSC technique for ileostomy wound is associated with a reduced risk of surgical site infection apparently without influencing the duration of operation and length of hospital stay.
authors.affiliation: Department of General, Endoscopic & Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, UK and Department of General & Colorectal Surgery, Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, UK surgeon1wrh@hotmail.com.
authors.forename: Muhammad Shafique
authors.initials: MS
authors.lastname: Sajid
authors.affiliation: Department of General, Endoscopic & Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, UK and Department of General & Colorectal Surgery, Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, UK.
authors.forename: Muhammad I
authors.initials: MI
authors.lastname: Bhatti
authors.affiliation: Department of General, Endoscopic & Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, UK and Department of General & Colorectal Surgery, Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, UK.
authors.forename: William Fa
authors.initials: WF
authors.lastname: Miles
keywords: ileostomy closure; linear wound closure; purse-string wound closure; stoma closure