Comparison of Efficacy Between Linear Versus Purse String Skin Closure at Loop Ileostomy Reversal
DOI:
https://doi.org/10.37762/jgmds.13-3.829Keywords:
Loop Ileostomy Reversal, Post-SSIs, Linear Skin Closure, Purse String Skin ClosureAbstract
ABSTRACT
OBJECTIVES
This study aimed to compare postoperative surgical site infection (SSI) rates and LOS between linear and purse-string skin closure during loop ileostomy reversal.
METHODOLOGY
This randomized controlled trial was conducted in the Department of General Surgery at MTI-HMC Peshawar from Jun 22 2020, to Jul 1 2025. patients fulfilling the inclusion criteria, undergoing stoma reversal, were enrolled to either linear (Group A) or PS (Group B) wound closure groups, while 63 patients with stoma site infection (TLC >11,000/L with fever) were excluded from the sample size (Figure 1: CONSORT Flow Diagram). Length of hospital stay was recorded, and patients were followed for 30 days to assess for SSI. This trial was registered in Clinical Trials with NCT # NCT07573423.
RESULTS
A total of 252 patients were randomized equally into two groups (126 per group). SSI occurred in 47 (37.3%) in Group A (Linear Skin Closure - LSC), compared with 9 (7.14%) in Group B (Purse String Closure - PS) (p<0.001). Mean hospital stay was significantly shorter in group B (4.1±1.1) compared to group A (4.5±1.6) (p<0.001)
CONCLUSION
Purse-string skin closure following loop ileostomy reversal was significantly associated with a lower rate of SSI compared with linear skin closure. In addition, the LOS was shorter with purse-string closure, suggesting that it is a safe and recommended technique for routine use to reduce post-operative wound complications.
Downloads
Metrics
References
Aga E, Keinan-Boker L, Eithan A, Mais T, Rabinovich A, Nassar F. Surgical site infections after abdominal surgery: incidence and risk factors. A prospective cohort study. Infect Dis (Lond). 2015;47(11):761–7. doi:10.3109/23744235.2015.1055587 PubMed PMID: 26114986 DOI: https://doi.org/10.3109/23744235.2015.1055587
Wada Y, Miyoshi N, Ohue M, Noura S, Fujino S, Sugimura K, et al. Comparison of surgical techniques for stoma closure: A retrospective study of purse‑string skin closure versus conventional skin closure following ileostomy and colostomy reversal. Molecular and Clinical Oncology. 2015 May 1;3(3):619–22. doi:10.3892/mco.2015.505 DOI: https://doi.org/10.3892/mco.2015.505
Nota SPFT, Braun Y, Ring D, Schwab JH. Incidence of surgical site infection after spine surgery: what is the impact of the definition of infection? Clin Orthop Relat Res. 2015 May;473(5):1612–9. doi:10.1007/s11999-014-3933-y PubMed PMID: 25212963; PubMed Central PMCID: PMC4385381 DOI: https://doi.org/10.1007/s11999-014-3933-y
Gonzalez DO, Ambeba E, Minneci PC, Deans KJ, Nwomeh BC. Surgical site infection after stoma closure in children: outcomes and predictors. J Surg Res. 2017 Mar;209:234–41. doi:10.1016/j.jss.2016.10.029 PubMed PMID: 28032565 DOI: https://doi.org/10.1016/j.jss.2016.10.029
Alvandipour M, Gharedaghi B, Khodabakhsh H, Karami MY. Purse-String Versus Linear Conventional Skin Wound Closure of an Ileostomy: A Randomized Clinical Trial. Ann Coloproctol. 2016 Aug 31;32(4):144–9. doi:10.3393/ac.2016.32.4.144 DOI: https://doi.org/10.3393/ac.2016.32.4.144
Sathasivam Sureshkumar, Kunnathoor Jubel, Manwar S. Ali. Comparing Surgical Site Infection and Scar Cosmesis Between Conventional Linear Skin Closure Versus Purse-string Skin Closure in Stoma Reversal - A Randomized Controlled Trial | Cureus [Internet]. [cited 2025 Nov 16]. Available from: https://www.cureus.com/articles/10737-comparing-surgical-site-infection-and-scar-cosmesis-between-conventional-linear-skin-closure-versus-purse-string-skin-closure-in-stoma-reversal---a-randomized-controlled-trial#!/
Hajibandeh S, Hajibandeh S, Maw A. Purse‐string skin closure versus linear skin closure in people undergoing stoma reversal. Cochrane Database of Systematic Reviews. 2024;(3). doi:10.1002/14651858.CD014763.pub2 DOI: https://doi.org/10.1002/14651858.CD014763.pub2
Maciej Borejsza-Wysocki, Krzysztof Szmyt, Pamela Jeske, Adam Bobkiewicz, Witold Ledwosiński. Analysis of risk factors for surgical site infection and other post-operative complications in patients following loop ileostomy reversal [Internet]. [cited 2025 Nov 16]. Available from: https://ppch.pl/article/544604/en
wnarifin.github.io > Sample size calculator [Internet]. [cited 2025 Sep 18]. Available from: https://wnarifin.github.io/ssc/sssnsp.html
O’Leary DP, Carter M, Wijewardene D, Burton M, Waldron D, Condon E, et al. The effect of purse-string approximation versus linear approximation of ileostomy reversal wounds on morbidity rates and patient satisfaction: the ‘STOMA’ trial. Tech Coloproctol. 2017 Nov 1;21(11):863–8. doi:10.1007/s10151-017-1713-x DOI: https://doi.org/10.1007/s10151-017-1713-x
Khokhar MA, Ahmad A, Rehman IU, Imtiaz T, Najeeb E, Haq MBU, et al. Outcomes of Purse-string versus Conventional Linear Suture Closure of the Skin Wound Following Ileostomy Reversal. Journal of Islamabad Medical & Dental College. 2024 Apr 15;13(1):137–42. doi:10.35787/jimdc.v13i1.1114 DOI: https://doi.org/10.35787/jimdc.v13i1.1114
Shah M, Ullah R, Babar Y, Khan A. COMPARISON BETWEEN CONVENTIONAL LINEAR VERSUS PURSE-STRING SUTURING: A RANDOMIZED CONTROLLED TRIAL. J Popl Ther Clin Pharmacol. 2024 Jan 24;31(1):1316–20. doi:10.53555/jptcp.v31i1.4176 DOI: https://doi.org/10.53555/jptcp.v31i1.4176
Tiwari MK, Yadav R, Mathur RM, Shrivastava CP. Mediastinal bronchogenic cyst presenting with dysphagia and back pain. Lung India. 2010;27(2):86–8. doi:10.4103/0970-2113.63612 PubMed PMID: 20616941; PubMed Central PMCID: PMC2893431 DOI: https://doi.org/10.4103/0970-2113.63612
Tan SBT, Lin X, Rosley MF, Lamparelli M, Tan SBT, Lin X, et al. Pre-operative Serum Albumin as a Predictor of Adverse Outcomes in Open Abdominal Surgery: A Retrospective Study in Central Queensland. Cureus. 2025 Feb 26;17(2). doi:10.7759/cureus.79681 DOI: https://doi.org/10.7759/cureus.79681
Ameer A, Mirza MB, Talat N. The Outcome of Purse-string Versus Conventional Wound Closure Techniques in Patients Undergoing Stoma Reversal: A Randomized Controlled Trial. Journal of Pediatric Surgery. 2024 Jun 1;59(6):1186–9. doi:10.1016/j.jpedsurg.2023.10.062 PubMed PMID: 37978002 DOI: https://doi.org/10.1016/j.jpedsurg.2023.10.062
Carannante F, Costa G, Miacci V, Bianco G, Masciana G, Lauricella S, et al. Comparison of purse-string technique vs linear suture for skin closure after ileostomy reversal. A randomized controlled trial. Langenbecks Arch Surg. 2024 Apr 27;409(1):141. doi:10.1007/s00423-024-03332-w DOI: https://doi.org/10.1007/s00423-024-03332-w
Anestiadou E, Stamiris S, Ioannidis O, Symeonidis S, Bitsianis S, Bougioukas K, Karagiannis T, Kotidis E, Pramateftakis MG, Mantzoros I, Cheva A, et al. Comparison of negative pressure wound therapy systems and conventional non-pressure dressings on surgical site infection rate after stoma reversal: systematic review and meta-analysis of randomized controlled trials. J Clin Med. 2025;14(5):1654. https://doi.org/10.3390/jcm14051654. PMID: 40111521 DOI: https://doi.org/10.3390/jcm14051654
Peltrini R, Ferrara F, Parini D, Pacella D, Vitiello A, Scognamillo F, Pilone V, Pietroletti R, De Nardi P, et al. Current approach to loop ileostomy closure: a nationwide survey on behalf of the Italian Society of ColoRectal Surgery (SICCR). Updates Surg. 2025;77(1):97-106. https://doi.org/10.1007/s13304-024-02033-9. PMID: 39520612 DOI: https://doi.org/10.1007/s13304-024-02033-9
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Naseeb Ali, Shahid Munir, Gohar Ali; Muhammad Kashif Dawar, Muhammad Bilal; Muhammad shah; Muhammad Ayub
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
