Abstract
Purpose
Surgical site infection (SSI) is the most common complication after primary closure of defunctioning ileostomy. We use a subcutaneous vacuum drain (SVD) in our institution to prevent infection. This study aimed to analyze the risk factors of SSI and to assess the utility of an SVD for preventing SSI in patients undergoing primary closure of ileostomy.
Methods
Patients undergoing ileostomy closure in the Department of Colorectal Surgery, Peking University Cancer Hospital, from September 2006 to March 2013, were included in this study. The clinical features of these patients with or without a subcutaneous drain were reviewed, and the complication rate of SSI was analyzed. The primary endpoints were the incidence and risk factors of SSI, and the secondary endpoints were the rate of overall complications and their management.
Results
A total of 245 consecutive patients were enrolled in the study. The overall incidence of SSI was 8.6 %. Eighty-five (34.7 %) patients received placement of an SVD. The use of SVDs was associated with a significantly lower incidence of SSI compared with primary closure (PC) without an SVD (1.2 vs. 12.5 %, p = 0.001). Multivariate analyses showed that the presence of an SVD (odds ratio (OR) 0.063, p = 0.012), total operation time >90 min (OR 4.862, p = 0.002), and postoperative complications (OR 10.576, p < 0.001) were independent risk factors of SSI.
Conclusions
This study shows that an SVD is effective for reducing SSI in patients undergoing PC of ileostomy. Further randomized trials are required to confirm our findings and to compare SVDs with purse-string sutures.
Similar content being viewed by others
References
Tan WS et al (2009) Meta-analysis of defunctioning stomas in low anterior resection for rectal cancer. Br J Surg 96(5):462–72
Huser N et al (2008) Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery. Ann Surg 248(1):52–60
Ulrich AB et al (2009) Diverting stoma after low anterior resection: more arguments in favor. Dis Colon Rectum 52(3):412–8
Kalady MF et al (2003) Loop ileostomy closure at an ambulatory surgery facility: a safe and cost-effective alternative to routine hospitalization. Dis Colon Rectum 46(4):486–90
Lahat G et al (2005) Wound infection after ileostomy closure: a prospective randomized study comparing primary vs. delayed primary closure techniques. Tech Coloproctol 9(3):206–8
Milanchi S et al (2009) Wound infection after ileostomy closure can be eliminated by circumferential subcuticular wound approximation. Dis Colon Rectum 52(3):469–74
Vermulst N et al (2006) Primary closure of the skin after stoma closure. Management of wound infections is easy without (long-term) complications. Dig Surg 23(4):255–8
Wong KS et al (2005) Loop ileostomy closure after restorative proctocolectomy: outcome in 1,504 patients. Dis Colon Rectum 48(2):243–50
Taylor GD et al (1995) The effect of surgical wound infection on postoperative hospital stay. Can J Surg 38(2):149–53
Banerjee A (1997) Pursestring skin closure after stoma reversal. Dis Colon Rectum 40(8):993–4
Hackam DJ, Rotstein OD (1995) Stoma closure and wound infection: an evaluation of risk factors. Can J Surg 38(2):144–8
Gunderson LL et al (2010) Revised tumor and node categorization for rectal cancer based on surveillance, epidemiology, and end results and rectal pooled analysis outcomes. J Clin Oncol 28(2):256–63
Tsujita E et al (2012) Subcuticular absorbable suture with subcutaneous drainage system prevents incisional SSI after hepatectomy for hepatocellular carcinoma. World J Surg 36(7):1651–6
Chowdri NA et al (2007) Role of subcutaneous drains in obese patients undergoing elective cholecystectomy: a cohort study. Int J Surg 5(6):404–7
Hellums EK, Lin MG, Ramsey PS (2007) Prophylactic subcutaneous drainage for prevention of wound complications after cesarean delivery—a metaanalysis. Am J Obstet Gynecol 197(3):229–35
Fujii T et al (2011) Effects of subcutaneous drain for the prevention of incisional SSI in high-risk patients undergoing colorectal surgery. Int J Color Dis 26(9):1151–5
Van Cutsem E et al (2009) Cetuximab and chemotherapy as initial treatment for metastatic colorectal cancer. N Engl J Med 360(14):1408–17
Mangram AJ et al (1999) Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 20(4):250–78, quiz 279-80
Dusch N et al (2013) Randomized controlled trial: comparison of two surgical techniques for closing the wound following ileostomy closure: purse string vs direct suture. Color Dis 15(8):1033–40
Lee JR 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(2):58–63
Dusch N, et al. (2013) Randomised controlled trial: comparison of two surgical techniques closing the wound following ileostomy closure: purse string versus direct suture. Color Dis
Reid K et al (2010) Randomized clinical trial of short-term outcomes following purse-string versus conventional closure of ileostomy wounds. Br J Surg 97(10):1511–7
Nakamura Y et al (2008) PDGF-BB is a novel prognostic factor in colorectal cancer. Ann Surg Oncol 15(8):2129–36
Magann EF et al (2002) Subcutaneous stitch closure versus subcutaneous drain to prevent wound disruption after cesarean delivery: a randomized clinical trial. Am J Obstet Gynecol 186(6):1119–23
Baier PK et al (2010) Subcutaneous Redon drains do not reduce the incidence of surgical site infections after laparotomy. A randomized controlled trial on 200 patients. Int J Colorectal Dis 25(5):639–43
Ramsey PS et al (2005) Subcutaneous tissue reapproximation, alone or in combination with drain, in obese women undergoing cesarean delivery. Obstet Gynecol 105(5 Pt 1):967–73
Cardosi RJ et al (2006) Subcutaneous management of vertical incisions with 3 or more centimeters of subcutaneous fat. Am J Obstet Gynecol 195(2):607–14, discussion 614-6
Konishi T et al (2006) Elective colon and rectal surgery differ in risk factors for wound infection: results of prospective surveillance. Ann Surg 244(5):758–63
Sharma A et al (2013) Closure of defunctioning loop ileostomy is associated with considerable morbidity. Colorectal Dis 15(4):458–62
Phatak UR, et al. (2013) Impact of ileostomy-related complications on the multidisciplinary treatment of rectal cancer. Ann Surg Oncol
Akiyoshi T et al (2010) Complications of loop ileostomy closure in patients with rectal tumor. World J Surg 34(8):1937–42
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pan, HD., Wang, L., Peng, YF. et al. Subcutaneous vacuum drains reduce surgical site infection after primary closure of defunctioning ileostomy. Int J Colorectal Dis 30, 977–982 (2015). https://doi.org/10.1007/s00384-015-2168-z
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-015-2168-z