A Comparative Study between Purse-String and Linear Skin Closure after Intestinal Ostomy Reversion and Post Operative Outcome

Abstract

Introduction: The use of a temporary diverting stoma has been shown to decrease septic consequences after high risk intestinal anastomosis. Following an ileostomy or colostomy reversal, wound infection is a well-accepted complication. Bacteria on the skin near the ileostomy or colostomy that have come into prolonged contact with bowel contents, are the main reason behind post-operative wound infections. As of yet, there is no consensus on the best stoma closure method to reduce postoperative SSI. Materials and Methods: This prospective study was conducted in different surgery units of Mymensingh Medical College Hospital from May, 2015 to November, 2015. The patients were distributed into two groups: linear skin closure (group L) and purse string closure (group P). Surgical site infection, cosmetic outcome, patient’s satisfaction, mean hospital stay were compared between two groups. Quantitative data were analyzed by t-test while qualitative data were evaluated by chi-square test. Results: In the present study, 50 patients with ileostomy or colostomy (end, loop or double barrel) were included where 25 patients were included in each study group. There were no significant differences in demographic variables between two groups. The mean time duration from ileostomy or colostomy to reversal was 126.48±4.7 days in group L and 131.96±6.7 days in group P. The mean operative time was 96.2±12.6 minutes in group L and 89.6±2.3 minutes in group P. Mean hospital stay was between group-L and group-P were 10.68±± days and 6.68±1.2 days respectively which was statistically significant (p<0.05). Surgical site infection was found in 3 cases (12%) in group L and in 0 case (0%) in group p. Operative complications like lower GI bleeding, diarrhea, paralytic ileus and sub-acute intestinal obstruction were not significantly varied between two groups. The mean score of cosmetic outcome between group-L and group-P done by visual analog scale were 4.2 and 8.7 respectively which was statistically significant (p=0.001). Conclusion: This study shows that, purse string skin closure after intestinal ostomy reversion is superior to conventional linear skin closure in some circumstances. The SSI rate is significantly lower in purse string than linear closure group. Patient’s satisfaction level is higher in purse string closure group, cosmetic outcome is also better. Less limitation of daily activity as hospital stay period is shorter in purse string group.