Comparison of purse-string technique versus linear suture for skin closure after stoma reversal: a meta-analysis of high-quality studies.

PURPOSE: Stoma reversal is associated with notable postoperative morbidity. Several techniques exist for skin closure after stoma reversal, with linear primary closure (LC) and purse-string closure (PS) being the most common. This systematic review and meta-analysis aim to compare LC and PS skin closure after stoma reversal in terms of surgical site infection (SSI) rates, wound healing, and cosmesis.

METHODS

In accordance with the PRISMA statement, a systematic review of skin closure after stoma reversal was conducted using MEDLINE (PubMed), Embase, Web of Science, and Scopus.

RESULTS

Eleven studies, enrolling 1,052 patients (PS, n=534; LC, n=518), published between 2006 and 2024, were included. The overall quality of the studies was considered acceptable, with a mean Jadad scale score of 4 (range, 3-5). Patients underwent ileostomy or ileostomy/colostomy in 6 and 5 studies, respectively. No differences were observed between groups in operative time, length of hospital stay, intestinal obstruction, or incisional hernia. However, SSI and overall infection rates were higher in the LC group, with a statistically significant difference for SSI.

CONCLUSION

Skin closure following stoma reversal using the PS technique may offer advantages over LC. PS is associated with significantly lower SSI rates compared to LC. Although a large randomized controlled trial with long-term follow-up is still required, current findings suggest that PS could be considered the standard of care for wound closure after ileostomy reversal.