Circular (purse-string) vs primary skin closure following stoma closure: an up-to-date systematic review and meta-analysis

Abstract

Ostomy closure; Postoperative complications; Surgical wound infection

Cierre de ostomía; Complicaciones postoperatorias; Infección de herida quirúrgica

Tancament d'ostomia; Complicacions postoperatòries; Infecció de la ferida quirúrgica

Background Surgical site infections (SSI) are the most common complication after stoma closure. Circular skin closure (CSC) has been proposed to reduce SSI with comparable or even better outcomes than conventional primary sutures (PS). The aim of this meta-analysis is to compare circular with primary skin closure in stoma closure. Method A systematic review of the literature was performed for articles published between January 2010 and June 2023, including all randomized control trials (RCT) on wound infection of adult patients following stoma reversal. The primary outcome was 30-day SSI; secondary outcomes were operative time, length of stay, and incisional hernia. Results Eight RCTs were identified that included a total of 606 patients undergoing stoma closure surgery. Four percent of patients in the CSC group developed SSI, compared to 27% of patients undergoing PS. The 30-day SSI rate was lower after the circular skin closure (OR 0.11, 95% CI 0.06–0.21; p < 0.00001, I2 = 0%). There was no difference in the operative time (99.2 vs 103.5 min; MD − 0.17, 95% CI − 0.37, 0.03; p = 0.10), length of stay (7.1 vs 7.7 days; MD − 0.34, 95% CI − 0.55, − 0.12; p = 0.002), and incisional hernia rate (2% vs 4%; OR 0.61, 95% CI 0.23, 1.60; p = 0.31). Conclusion CSC is associated with lower SSI rate and should be preferred to linear skin closure technique after stoma closure surgery.