Skip to main content

Advertisement

Log in

A comparison of surgical site infections in children after stoma reversal between purse-string and linear closure

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Background

To reduce the surgical site infections (SSI), the purse-string closure technique has been widely performed and has also been recommended in adult stoma reversal. However, for children, some debate still exists. This study aims to compare the SSI rates in children between the purse-string and the linear for the skin closure of stoma reversal.

Methods

The data were collected from pediatric patients, who had undergone either purse-string or linear closure for elective surgery of stoma reversal from two university hospitals between January 2016 and December 2019.

Results

The purse-string and linear closure had been performed on 31 and 45 patients, respectively. At 30 days after surgery, three patients in the purse-string closure group had developed SSI compared to 14 patients in the linear closure group (9.7 vs. 31.1%, p = 0.028). Furthermore, there had been no significant difference in the overall post-operative complications. In multivariate analysis, the SSI had been significantly lower in patients with purse-string closure (OR 0.21, 95% CI 0.05–0.86, p = 0.029).

Conclusion

By employing the purse-string closure technique for skin closure of stoma reversal, there had been a significantly lower SSI rate compared to linear closure with no difference in the length of hospital stay.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Gonzalez DO, Ambeba E, Minneci PC, Deans KJ, Nwomeh BC (2017) Surgical site infection after stoma closure in children: outcomes and predictors. J Surg Res 209:234–241. https://doi.org/10.1016/j.jss.2016.10.029

    Article  PubMed  Google Scholar 

  2. Rickwood AMK, Hemalatha V, Brooman P (1979) Closure of colostomy in infants and children. Br J Surg 66:273–274. https://doi.org/10.1002/bjs.1800660417

    Article  CAS  PubMed  Google Scholar 

  3. Kiely EM, Sparnon AL (1987) Stoma closure in infants and children. Pediatr Surg Int 2:95–97. https://doi.org/10.1007/BF00174181

    Article  Google Scholar 

  4. Chandramouli B, Srinivasan K, Jagdish S, Ananthakrishnan N (2004) Morbidity and mortality of colostomy and its closure in children. J Pediatr Surg 39:596–599. https://doi.org/10.1016/j.jpedsurg.2003.12.016

    Article  CAS  PubMed  Google Scholar 

  5. Miyano G, Yanai T, Okazaki T, Kobayashi H, Lane G, Yamataka A (2007) Laparoscopy-assisted stoma closure. J Laparoendosc Adv Surg Tech A 17:395–398. https://doi.org/10.1089/lap.2006.0074

    Article  PubMed  Google Scholar 

  6. Bischoff A, Levitt MA, Lawal TA, Peña A (2010) Colostomy closure: how to avoid complications. Pediatr Surg Int 26:1087–1092. https://doi.org/10.1007/s00383-010-2690-6

    Article  PubMed  PubMed Central  Google Scholar 

  7. Banerjee A (1997) Pursestring skin closure after stoma reversal. Dis Colon Rectum 40:993–994. https://doi.org/10.1007/BF02051210

    Article  CAS  PubMed  Google Scholar 

  8. Sutton CD, Williams N, Marshall LJ, Lloyd G, Thomas WM (2002) A technique for wound closure that minimizes sepsis after stoma closure. ANZ J Surg 72:766–767. https://doi.org/10.1046/j.1445-2197.2002.02514.x

    Article  PubMed  Google Scholar 

  9. McCartan DP, Burke JP, Walsh SR, Coffey JC (2013) Purse-string approximation is superior to primary skin closure following stoma reversal: a systematic review and meta-analysis. Tech Coloproctol 17:345–351. https://doi.org/10.1007/s10151-012-0970-y

    Article  CAS  PubMed  Google Scholar 

  10. Li LT, Hicks SC, Davila JA, Kao LS, Berger RL, Arita NA et al (2014) Circular closure is associated with the lowest rate of surgical site infection following stoma reversal: a systematic review and multiple treatment meta-analysis. Color Dis 16:406–416. https://doi.org/10.1111/codi.12556

    Article  CAS  Google Scholar 

  11. Gachabayov M, Lee H, Chudner A, Dyatlov A, Zhang N, Bergamaschi R (2019) Purse-string vs. linear skin closure at loop ileostomy reversal: a systematic review and meta-analysis. Tech Coloproctol 23:207–220. https://doi.org/10.1007/s10151-019-01952-9

    Article  CAS  PubMed  Google Scholar 

  12. Horan TC, Andrus M, Dudeck MA (2008) CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 36:309–332. https://doi.org/10.1016/j.ajic.2008.03.002

    Article  Google Scholar 

  13. Çavuşoğlu YH, Karaman A, Afşarlar ÇE, Karaman İ, Erdoğan D, Özgüner İF (2015) Ostomy closures in children: variations in perioperative care do not change the outcome. Indian J Surg 77:1131–1136. https://doi.org/10.1007/s12262-015-1212-0

    Article  PubMed  PubMed Central  Google Scholar 

  14. Porras-Hernandez J, Bracho-Blanchet E, Tovilla-Mercado J, Vilar-Compte D, Nieto-Zermeño J, Davila-Perez R et al (2008) A standardized perioperative surgical site infection care process among children with stoma closure: a before-after study. World J Surg 32:2316–2323. https://doi.org/10.1007/s00268-008-9617-6

    Article  PubMed  Google Scholar 

  15. Ares GJ, Helenowski I, Hunter CJ, Madonna M, Reynolds M, Lautz T (2017) Effect of preadmission bowel preparation on outcomes of elective colorectal procedures in young children. J Pediatr Surg. https://doi.org/10.1016/j.jpedsurg.2017.03.060

    Article  PubMed  Google Scholar 

  16. Nordin AB, Sales SP, Besner GE, Levitt MA, Wood RJ, Kenney BD (2018) Effective methods to decrease surgical site infections in pediatric gastrointestinal surgery. J Pediatr Surg 53:52–59. https://doi.org/10.1016/j.jpedsurg.2017.10.018

    Article  Google Scholar 

  17. Ahmad H, Nordin AB, Halleran DR, Kenney B, Jaggi P, Gasior A et al (2020) Decreasing surgical site infections in pediatric stoma closures. J Pediatr Surg 55:90–95. https://doi.org/10.1016/j.jpedsurg.2019.09.058

    Article  PubMed  Google Scholar 

  18. Örtqvist L, Almström M, Öjmyr-Joelsson M, Wigander H, Währner A, Wester T (2011) Cosmetic and functional outcome after stoma site skin closure in children. Pediatr Surg Int 27:1123–1126. https://doi.org/10.1007/s00383-011-2933-1

    Article  PubMed  Google Scholar 

  19. O’Leary DP, Carter M, Wijewardene D, Burton M, Waldron D, Condon E et al (2017) The effect of purse-string approximation versus linear approximation of ileostomy reversal wounds on morbidity rates and patient satisfaction: the “STOMA” trial. Tech Coloproctol 21:863–868. https://doi.org/10.1007/s10151-017-1713-x

    Article  PubMed  Google Scholar 

  20. Reid K, Pockney P, Pollitt T, Draganic B, Smith SR (2010) Randomized clinical trial of short-term outcomes following purse-string versus conventional closure of ileostomy wounds. Br J Surg 97:1511–1517. https://doi.org/10.1002/bjs.7151

    Article  CAS  PubMed  Google Scholar 

  21. Milanchi S, Nasseri Y, Kidner T, Fleshner P (2009) Wound infection after ileostomy closure can be eliminated by circumferential subcuticular wound approximation. Dis Colon Rectum 52:469–474. https://doi.org/10.1007/DCR.0b013e31819acc90

    Article  PubMed  Google Scholar 

  22. Dusch N, Goranova D, Herrle F, Niedergethmann M, Kienle P (2013) Randomized controlled trial: comparison of two surgical techniques for closing the wound following ileostomy closure: purse string vs direct suture. Color Dis 15:1033–1040. https://doi.org/10.1111/codi.12211

    Article  CAS  Google Scholar 

  23. Lee JR, Kim YW, Sung JJ, Song OP, Kim HC, Lim CW et al (2011) Conventional linear versus purse-string skin closure after loop ileostomy reversal: comparison of wound infection rates and operative outcomes. J Korean Soc Coloproctol 27:58–63. https://doi.org/10.3393/jksc.2011.27.2.58

    Article  PubMed  PubMed Central  Google Scholar 

  24. Bucher BT, Guth RM, Elward AM, Hamilton NA, Dillon PA, Warner BW et al (2011) Risk factors and outcomes of surgical site infection in children. J Am Coll Surg 212:1033–1038. https://doi.org/10.1016/j.jamcollsurg.2011.01.065

    Article  PubMed  Google Scholar 

  25. Bhattacharyya N, Kosloske AM, Macarthur C (1990) Postoperative wound infection in pediatric surgical patients: a study of 676 infants and children. J Pediatr Surg 25:125–129. https://doi.org/10.1016/s0022-3468(05)80177-0

    Article  CAS  PubMed  Google Scholar 

  26. Pough K, Bhakta R, Maples H, Honeycutt M, Vijayan V (2020) Evaluation of pediatric surgical site infections associated with colorectal surgeries at an Academic Children’s Hospital. Healthcare 8:91. https://doi.org/10.3390/healthcare8020091

    Article  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kanokrat Thaiwatcharamas.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sayuen, C., Phannua, R., Chusilp, S. et al. A comparison of surgical site infections in children after stoma reversal between purse-string and linear closure. Pediatr Surg Int 38, 149–156 (2022). https://doi.org/10.1007/s00383-021-05011-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-021-05011-z

Keywords

Navigation