• Meng-Chiao Hsieh, Liang-Tseng Kuo, Ching-Chi Chi, Wen-Shih Huang, and Chih-Chien Chin.
• 1 Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan 2 Centre for Evidence-Based Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan 3 Division of Sports Medicine, Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan 4 Department of Dermatology, Chang Gung Memorial Hospital, Chiayi, Taiwan 5 Graduate Institutes of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan 6 College of Medicine, Chang Gung University, Taoyuan, Taiwan.
• Dis. Colon Rectum. 2015 Aug 1; 58 (8): 808-15.

BackgroundStoma reversal is a surgical procedure commonly used following temporary defunctioning stoma surgery. Surgical site infection is one of the most common postoperative morbidities. A few skin closure methods have been developed to decrease surgical site infection. However, the optimal skin closure method is still in debate.ObjectiveThe aim of this study was to compare the surgical site infection rate and other postoperative outcomes between the pursestring closure and conventional primary closure techniques.Data SourcesWe searched the MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for relevant trials.Study SelectionWe conducted a meta-analysis of randomized controlled trials that compared the surgical outcomes following pursestring closure and conventional primary closure techniques.InterventionWe conducted the meta-analysis by using the random-effects model.Main Outcome MeasuresThe primary outcome of interest was surgical site infection following stoma reversal within 30 days after operation.ResultsThis meta-analysis included 4 randomized controlled trials with a total of 319 participants (162 in the pursestring closure group and 157 in the conventional primary closure group). Compared with the conventional primary closure group, the pursestring closure group had a significant decrease in surgical site infection (risk difference, -0.25; 95% CI, -0.36 to -0.15; p < 0.00001; number needed to treat = 4) and higher satisfaction with cosmetic outcomes (standard mean difference, 0.7; 95% CI, 0.13-1.27; p = 0.02). No other significant differences in operative time, length of hospital stay, and wound healing time were found between the 2 groups.LimitationsThis study was limited to the lack of double blinding and long-term follow-up in the included trials.ConclusionsPursestring closure has significantly fewer surgical site infections and achieves better cosmetic outcomes following stoma reversal than conventional primary closure.

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