International Journal of Colorectal Disease

, Volume 33, Issue 7, pp 973–977 | Cite as

Purse-string closure technique reduces the incidence of incisional hernias following the reversal of temporary ileostomy

  • Mazen A. Juratli
  • Nour-Eldin A. Nour-Eldin
  • Hans Ackermann
  • Nils Habbe
  • Sabine Hannes
  • Wolf O. Bechstein
  • Guido Woeste
Original Article



The incidence of incisional hernia (IH) at ileostomy closure site has not been sufficiently evaluated. Temporary loop ileostomy is routinely used in patients after low anterior resection for rectal cancer. The goal of this study was to compare the IH rates of standard suture skin closure and purse-string skin closure techniques.

Patients and methods

Patients undergoing ileostomy reversal and follow-up CT scan at the University Hospital Frankfurt between January 2009 and December 2015 were retrospectively analyzed regarding IH and associated risk factors. Patients received either direct stitch skin closure (group DC) or purse-string skin closure (group PS).


In total, 111 patients underwent ileostomy reversal in the aforementioned period. In 88 patients, a CT scan was performed 12–24 months after ileostomy reversal for cancer follow-up. Median follow-up was 12 months. Median time interval between ileostoma formation and closure was 12 (± 4 SD) weeks. In 19 of 88 patients (21.5%), an IH was detected. The incidence of IH detected by CT scan was significantly lower in the PS group (n = 7, 12.9%) compared to the DC group (n = 12, 35.2%, p = 0.017).


This retrospective study shows an advantage of the purse-string skin closure technique in ileostomy reversals. The use of this technique for skin closure following ileostomy reversals is recommended to reduce the IH rates. Randomized controlled trials are needed to confirm these findings.


Ileostoma closure Incisional hernia Purse-string skin closure Rectal cancer Wound infection 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Mazen A. Juratli
    • 1
  • Nour-Eldin A. Nour-Eldin
    • 2
    • 3
  • Hans Ackermann
    • 4
  • Nils Habbe
    • 1
  • Sabine Hannes
    • 1
  • Wolf O. Bechstein
    • 1
  • Guido Woeste
    • 1
  1. 1.Department of General and Visceral SurgeryFrankfurt University HospitalFrankfurt am MainGermany
  2. 2.Institute of Diagnostic and Interventional RadiologyFrankfurt University HospitalFrankfurt am MainGermany
  3. 3.Department of Diagnostic and Interventional RadiologyCairo University HospitalCairoEgypt
  4. 4.Department of Biomedical StatisticsFrankfurt University HospitalFrankfurt am MainGermany

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