Surgical Site Infection After Stoma Reversal: A Comparison Between Linear and Purse-String Closure

Muhammad Awais Khan; Khurram Niaz; Shahzeb Asghar; Maaz A Yusufi; Mohtamam Nazir; Syed Muhammad Ali; Aryan Ahmed; Akeel Ahamed Salahudeen; Talha Kareem

doi:10.7759/cureus.50057

Surgical Site Infection After Stoma Reversal: A Comparison Between Linear and Purse-String Closure

Cureus. 2023 Dec 6;15(12):e50057. doi: 10.7759/cureus.50057. eCollection 2023 Dec.

Authors

Muhammad Awais Khan¹, Khurram Niaz², Shahzeb Asghar³, Maaz A Yusufi⁴, Mohtamam Nazir², Syed Muhammad Ali^{5

6}, Aryan Ahmed⁶, Akeel Ahamed Salahudeen⁷, Talha Kareem⁸

Affiliations

¹ Accident and Emergency, Frimley Health National Health Service (NHS) Foundation Trust, Surrey, GBR.
² General Surgery, Sheikh Zayed Medical College and Hospital, Rahim Yar Khan, PAK.
³ General Surgery, Multan Medical and Dental College, Multan, PAK.
⁴ General Surgery, University Hospitals Dorset National Health Service (NHS) Foundation Trust, Dorset, GBR.
⁵ Surgery, Weill Cornell Medical School, Doha, QAT.
⁶ Acute Care Surgery, Hamad General Hospital, Doha, QAT.
⁷ Surgery, Nishtar Hospital, Multan, PAK.
⁸ General Surgery, Nishtar Hospital, Multan, PAK.

Abstract

Introduction: Intestinal stomas are utilized for both benign and malignant conditions of the intestine to mitigate the risk of anastomotic leakage and re-exploration. However, stomas are associated with various complications, such as stoma necrosis, peri-stomal irritation, parastomal hernia, bleeding, bowel obstruction, and electrolyte abnormalities. Surgical site infection (SSI) is a significant source of morbidity following stoma reversal, leading to increased patient morbidity. The conventional method of stoma reversal involves closing the skin with non-absorbable sutures in a linear fashion, which is known as linear skin closure (LSC). Recently, a new method of skin closure using purse-string approximation (PSA) has been advocated, which allows healing by secondary intention. The rationale for this study is to compare the SSI associated with LSC and PSA after stoma reversal.

Objective: This study aims to compare the frequency of SSI between LSC and PSA in stoma reversal.

Materials and methods: The study was conducted at the Department of General Surgery, Shifa International Hospitals Ltd. (SIH), Islamabad, Pakistan. The study is a randomized controlled clinical trial carried out between the 14^th of March 2021 and the 22^nd of November 2022. The sampling technique was non-probability consecutive random sampling. The sample size was calculated using the WHO sample size calculator by using the hypothesis test for two population proportions. The minimum sample size in each group was 40 patients. The total sample size was 80 patients.

Results: The overall frequency of SSI in all the patients was 18/80 (22.5%). The frequency of SSI in Group 1 (LSC) was 6/40 (15.0%), and in Group 2 (PSA), it was 12/40 (30.0%). The frequency of SSI in Group 2 (PSA) was twice as high as in Group 1 (LSC); however, the p-value was calculated to be 0.108. Therefore, this difference was statistically insignificant.

Conclusions: While PSA has exhibited promise in reducing SSI rates and enhancing aesthetic outcomes and patient satisfaction, there is still enough data favoring LSC. Moreover, insufficient data is available for our population to make a definitive statement. Consequently, further research on this topic is warranted, preferably involving larger sample sizes and multicenter randomized controlled trials, to establish which technique is superior in SSI reduction.

Keywords: colostomy; ileostomy; linear skin closure; purse-string closure; stoma formation.