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Comparative analysis of purse-string method versus conventional methods for stoma closure

Year 2025, Volume: 11 Issue: 1, 1 - 6
https://doi.org/10.18621/eurj.1516656

Abstract

Objectives: Stoma surgery, essential for treating conditions like Crohn's disease, colorectal cancer, and diverticular disease, requires effective closure techniques to minimize postoperative complications and enhance patient outcomes. This study aims to compare the purse-string technique with traditional closure methods, emphasizing postoperative outcomes and complications.

Methods: This study retrospectively reviewed the medical records of 44 patients who underwent stoma closure at Antalya University Hospital between August 2015 and November 2019. Twenty-one patients underwent the purse-string (PS) method and twenty-three underwent conventional methods (CM). Patient demographics, such as age, sex, body mass index, and medical history, were recorded. Variables such as surgical duration, complication rates, and recovery periods were meticulously analyzed.

Results: The analysis indicated that patients treated with the PS method had notably reduced infection rates (9.5% in PS vs. 21.5% in CM) and quicker healing times compared to conventional methods. The circular suture pattern of the PS method demonstrated greater efficacy in minimizing postoperative complications. Complications were observed in 21.5% of patients with CM and 9.5% of patients with the PS method. Notably, systematic reviews have shown that the PS closure technique reduces surgical site infection (SSI) rates, although its impact on the length of hospital stay remains uncertain.

Conclusions: The PS method shows a significant advantage over traditional techniques in stoma closure. Its benefits in lowering infection rates and promoting quicker recovery emphasize its potential as a preferred method in surgical practice. The study advocates for the broader adoption of the PS method in clinical settings, given its positive impact on patient outcomes.

References

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  • 2. Shellito PC. Complications of abdominal stoma surgery. Dis Colon Rectum. 1998;41(12):1562-1572. doi: 10.1007/BF02237308.
  • 3. McErlain D, Kane M, McMgrogan M, Haughey S. Proapsed stoma. Nurs Stand. 2004;18(18):41-42. doi: 10.7748/ns2004.01.18.18.41.c3526.
  • 4. Baxter A, Salter M. Stoma care nursing. Nurs Stand. 2000;14(19):59. doi: 10.7748/ns2000.01.14.19.59.c2749.
  • 5. Cancer Research UK. Available at: http://www.cancerresearchuk.org. Accessed January 15, 2003.
  • 6. Robertson I, Eung E, Hughes D, et al. Prospective analysis of stoma related complications. Colorectal Dis. 2005;7(3):279-285. doi: 10.1111/j.1463-1318.2005.00785.x.
  • 7. Yaşan A, Ünal S, Gedik E, Girgin S. [Quality of life, depression and anxiety among patients who have undergone permanent or temporary ostomy]. Anatolian J Psychiatry. 2008;9(3):162-168. [Article in Turkish]
  • 8. Üstündağ H, Demir N, Zengin N, Gül A. [Body Image and Self-esteen in Patients with Stoma]. Turk Klin J Med Sci. 2007;27(4):522-527. [Article in Turkish]
  • 9. Arumugam PJ, Bevan L, Macdonald L, et al. A prospective audit of stomas - analysis of risk factors and complications and their management. Colorectal Dis. 2003;5(1):49-52. doi: 10.1046/j.1463-1318.2003.00403.x.
  • 10. Hackam DJ, Rotstein OD. Stoma closure and wound infection: an evaluation of risk factors. Can J Surg. 1995;38(2):144-148.
  • 11. Wong KS, Remzi FH, Gorgun E, et al. Loop ileostomy closure after restorative proctocolectomy: outcome in 1,504 patients. Dis Colon Rectum. 2005;48(2):243-250. doi: 10.1007/s10350-004-0771-0.
  • 12. Banerjee A. Pursestring skin closure after stoma reversal. Dis Colon Rectum. 1997;40(8):993-994. doi: 10.1007/BF02051210.
  • 13. Van Sprundel TC, Gerritsen van der Hoop A. Modified technique for parastomal hernia repair in patients with intractable stoma-care problems. Colorectal Dis. 2005;7(5):445-449. doi: 10.1111/j.1463-1318.2005.00820.x.
  • 14. Vignali A, Fazio VW, Lavery IC, et al. Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients. J Am Coll Surg. 1997;185(2):105-113. doi: 10.1016/S1072-7515(97)00018-5.
  • 15. Reese JB, Finan PH, Haythornthwaite JA, et al. Gastrointestinal ostomies and sexual outcomes: a comparison of colorectal cancer patients by ostomy status. Support Care Cancer. 2014;22(2):461-468. doi: 10.1007/s00520-013-1998-x.
  • 16. Rondelli F, Reboldi P, Rulli A, et al. Loop ileostomy versus loop colostomy for fecal diversion after colorectal or coloanal anastomosis: a meta-analysis. Int J Colorectal Dis. 2009;24(5):479-488. doi: 10.1007/s00384-009-0662-x.
  • 17. Kaiser AM, Israelit S, Klaristenfeld D, et al. Morbidity of ostomy takedown. J Gastrointest Surg. 2008;12(3):437-441. doi: 10.1007/s11605-007-0457-8.
  • 18. Song GW, Yu CS, Lee HO, et al. Ileostomy related complications. J Korean Soc Coloproctol. 2003;19(2):82-89.
  • 19. Atallah W, Karpuz Ş, Taghiyev A, Coşkun M. Comparing cosmetic results of purse-string closure vs conventional linear sutured closure of the stoma wound following loop ileostomy reversal. Turk J Colorectal Dis. 2018;28(4):153-158. doi: 10.4274/tjcd.97268.
  • 20. Camacho-Mauries D, Rodriguez-Díaz JL, Salgado-Nesme N, González QH, Vergara-Fernández O. Randomized clinical trial of intestinal ostomy takedown comparing pursestring wound closure vs conventional closure to eliminate the risk of wound infection. Dis Colon Rectum. 2013;56(2):205-211. doi: 10.1097/DCR.0b013e31827888f6.
  • 21. Li LT, Hicks SC, Davila JA, et al. Circular closure is associated with the lowest rate of surgical site infection following stoma reversal: a systematic review and multiple treatment meta-analysis. Colorectal Dis. 2014;16(6):406-16. doi: 10.1111/codi.12556.
  • 22. Murray BW, Cipher DJ, Pham T, Anthony T. The impact of surgical site infection on the development of incisional hernia and small bowel obstruction in colorectal surgery. Am J Surg. 2011;202(5):558-560. doi: 10.1016/j.amjsurg.2011.06.014.
  • 23. Keenan JE, Speicher PJ, Thacker JK, Walter M, Kuchibhatla M, Mantyh CR. The preventive surgical site infection bundle in colorectal surgery: an effective approach to surgical site infection reduction and health care cost savings. JAMA Surg. 2014;149(10):1045-1052. doi: 10.1001/jamasurg.2014.346.
Year 2025, Volume: 11 Issue: 1, 1 - 6
https://doi.org/10.18621/eurj.1516656

Abstract

References

  • 1. Makela JT, Turku PH, Laitinen ST. Analysis of late stomal complications following ostomy surgery. Ann Chir Gynaecol. 1997;86(4):305-310.
  • 2. Shellito PC. Complications of abdominal stoma surgery. Dis Colon Rectum. 1998;41(12):1562-1572. doi: 10.1007/BF02237308.
  • 3. McErlain D, Kane M, McMgrogan M, Haughey S. Proapsed stoma. Nurs Stand. 2004;18(18):41-42. doi: 10.7748/ns2004.01.18.18.41.c3526.
  • 4. Baxter A, Salter M. Stoma care nursing. Nurs Stand. 2000;14(19):59. doi: 10.7748/ns2000.01.14.19.59.c2749.
  • 5. Cancer Research UK. Available at: http://www.cancerresearchuk.org. Accessed January 15, 2003.
  • 6. Robertson I, Eung E, Hughes D, et al. Prospective analysis of stoma related complications. Colorectal Dis. 2005;7(3):279-285. doi: 10.1111/j.1463-1318.2005.00785.x.
  • 7. Yaşan A, Ünal S, Gedik E, Girgin S. [Quality of life, depression and anxiety among patients who have undergone permanent or temporary ostomy]. Anatolian J Psychiatry. 2008;9(3):162-168. [Article in Turkish]
  • 8. Üstündağ H, Demir N, Zengin N, Gül A. [Body Image and Self-esteen in Patients with Stoma]. Turk Klin J Med Sci. 2007;27(4):522-527. [Article in Turkish]
  • 9. Arumugam PJ, Bevan L, Macdonald L, et al. A prospective audit of stomas - analysis of risk factors and complications and their management. Colorectal Dis. 2003;5(1):49-52. doi: 10.1046/j.1463-1318.2003.00403.x.
  • 10. Hackam DJ, Rotstein OD. Stoma closure and wound infection: an evaluation of risk factors. Can J Surg. 1995;38(2):144-148.
  • 11. Wong KS, Remzi FH, Gorgun E, et al. Loop ileostomy closure after restorative proctocolectomy: outcome in 1,504 patients. Dis Colon Rectum. 2005;48(2):243-250. doi: 10.1007/s10350-004-0771-0.
  • 12. Banerjee A. Pursestring skin closure after stoma reversal. Dis Colon Rectum. 1997;40(8):993-994. doi: 10.1007/BF02051210.
  • 13. Van Sprundel TC, Gerritsen van der Hoop A. Modified technique for parastomal hernia repair in patients with intractable stoma-care problems. Colorectal Dis. 2005;7(5):445-449. doi: 10.1111/j.1463-1318.2005.00820.x.
  • 14. Vignali A, Fazio VW, Lavery IC, et al. Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients. J Am Coll Surg. 1997;185(2):105-113. doi: 10.1016/S1072-7515(97)00018-5.
  • 15. Reese JB, Finan PH, Haythornthwaite JA, et al. Gastrointestinal ostomies and sexual outcomes: a comparison of colorectal cancer patients by ostomy status. Support Care Cancer. 2014;22(2):461-468. doi: 10.1007/s00520-013-1998-x.
  • 16. Rondelli F, Reboldi P, Rulli A, et al. Loop ileostomy versus loop colostomy for fecal diversion after colorectal or coloanal anastomosis: a meta-analysis. Int J Colorectal Dis. 2009;24(5):479-488. doi: 10.1007/s00384-009-0662-x.
  • 17. Kaiser AM, Israelit S, Klaristenfeld D, et al. Morbidity of ostomy takedown. J Gastrointest Surg. 2008;12(3):437-441. doi: 10.1007/s11605-007-0457-8.
  • 18. Song GW, Yu CS, Lee HO, et al. Ileostomy related complications. J Korean Soc Coloproctol. 2003;19(2):82-89.
  • 19. Atallah W, Karpuz Ş, Taghiyev A, Coşkun M. Comparing cosmetic results of purse-string closure vs conventional linear sutured closure of the stoma wound following loop ileostomy reversal. Turk J Colorectal Dis. 2018;28(4):153-158. doi: 10.4274/tjcd.97268.
  • 20. Camacho-Mauries D, Rodriguez-Díaz JL, Salgado-Nesme N, González QH, Vergara-Fernández O. Randomized clinical trial of intestinal ostomy takedown comparing pursestring wound closure vs conventional closure to eliminate the risk of wound infection. Dis Colon Rectum. 2013;56(2):205-211. doi: 10.1097/DCR.0b013e31827888f6.
  • 21. Li LT, Hicks SC, Davila JA, et al. Circular closure is associated with the lowest rate of surgical site infection following stoma reversal: a systematic review and multiple treatment meta-analysis. Colorectal Dis. 2014;16(6):406-16. doi: 10.1111/codi.12556.
  • 22. Murray BW, Cipher DJ, Pham T, Anthony T. The impact of surgical site infection on the development of incisional hernia and small bowel obstruction in colorectal surgery. Am J Surg. 2011;202(5):558-560. doi: 10.1016/j.amjsurg.2011.06.014.
  • 23. Keenan JE, Speicher PJ, Thacker JK, Walter M, Kuchibhatla M, Mantyh CR. The preventive surgical site infection bundle in colorectal surgery: an effective approach to surgical site infection reduction and health care cost savings. JAMA Surg. 2014;149(10):1045-1052. doi: 10.1001/jamasurg.2014.346.
There are 23 citations in total.

Details

Primary Language English
Subjects Gastroenterology Surgery, Gastroenterology and Hepatology
Journal Section Original Articles
Authors

Amil Hüseynov 0000-0002-4138-9329

Veli Vural 0000-0002-2004-4049

Early Pub Date November 28, 2024
Publication Date
Submission Date July 15, 2024
Acceptance Date October 19, 2024
Published in Issue Year 2025 Volume: 11 Issue: 1

Cite

AMA Hüseynov A, Vural V. Comparative analysis of purse-string method versus conventional methods for stoma closure. Eur Res J. 11(1):1-6. doi:10.18621/eurj.1516656

e-ISSN: 2149-3189 


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