title: Pursestring closure of the stoma site leads to fewer wound infections: results from a multicenter randomized controlled trial.
abstract: BACKGROUND
  Surgical site infection after stoma reversal is common. The optimal skin closure technique after stoma reversal has been widely debated in the literature.
  
  
  OBJECTIVE
  We hypothesized that pursestring near-complete closure of the stoma site would lead to fewer surgical site infections compared with conventional primary closure.
  
  
  METHODS
  This study was a parallel prospective multicenter randomized controlled trial.
  
  
  METHODS
  This study was conducted at 2 university medical centers.
  
  
  METHODS
  Patients (N = 122) presenting for elective colostomy or ileostomy reversal were selected.
  
  
  METHODS
  Pursestring versus conventional primary closure of stoma sites were compared.
  
  
  METHODS
  Stoma site surgical site infection within 30 days of surgery, overall surgical site infection, delayed healing (open wound for >30 days), time to wound epithelialization, and patient satisfaction were the primary outcomes measured.
  
  
  RESULTS
  The pursestring group had a significantly lower stoma site infection rate (2% vs 15%, p = 0.01). There was no difference in delayed healing or patient satisfaction between groups. Time to epithelialization was measured in only 51 patients but was significantly longer in the pursestring group (34.6 ± 20 days vs 24.1 ± 17 days, p = 0.02).
  
  
  CONCLUSIONS
  This study was limited by the variability in procedures and surgeons, the limited follow-up after 30 days, and the inability to perform blinding.
  
  
  CONCLUSIONS
  Pursestring closure after stoma reversal has a lower risk of stoma site surgical site infection than conventional primary closure, although wounds may take longer to heal with the use of this approach.
  
  
  BACKGROUND
  NCT01713452 (www.clinicaltrials.gov).
authors.affiliation: 1Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota 2Department of Surgery, Mercy Clinic, Saint Louis, Missouri 3Division of Visceral Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
authors.forename: Janet T
authors.initials: JT
authors.lastname: Lee
authors.forename: Thao T
authors.initials: TT
authors.lastname: Marquez
authors.forename: Daniel
authors.initials: D
authors.lastname: Clerc
authors.forename: Olivier
authors.initials: O
authors.lastname: Gie
authors.forename: Nicolas
authors.initials: N
authors.lastname: Demartines
authors.forename: Robert D
authors.initials: RD
authors.lastname: Madoff
authors.forename: David A
authors.initials: DA
authors.lastname: Rothenberger
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Christoforidis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003125:Colostomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007081:Ileostomy; D007410:Intestinal Diseases / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D012307:Risk Factors; D054047:Surgical Stomas; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome; D058106:Wound Closure Techniques; D014945:Wound Healing; D055815:Young Adult