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Quality of life following ostomy reversal with purse-string vs linear skin closure: a systematic review

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

The importance of the defunctioning stoma on minimizing anastomotic leak in colorectal surgery is well established. However, a defunctioning stoma can substantially impact on quality of life (QoL). Circumferential purse-string approximation (PSA) and linear skin closure (LSC) are the most commonly performed surgical technique for reversal of stoma. The aim of this review was to systemically review and meta-analyze available randomized controlled trials (RCTs) comparing PSA and LSC.

Methods

An electronic systematic search using MEDLINE databases (PubMed, EMBASE, and Web of Science) of RCTs comparing PSA and LSC was performed. Eight RCTs totalling 647 patients met the inclusion criteria and were included in this meta-analysis.

Results

Patient’s satisfaction is significantly lower in PSA group during the first postoperative week, but it sharply improves afterwards and no difference were noted at 1 and 6 months between the two groups. Relative risk (RR) of developing a SSI is significantly lower in PSA compared to LSC group (RR 0.16 95% CI 0.09; 0.30; p = 0.0001), whereas incisional hernia (RR 0.53 95% CI 0.08; 3.53; p = 0.512), operative time (MD − 0.06 95% CI − 0.30; 0.17; p = 0.593), and hospital stay (MD − 0.09 (95% CI − 0.29-0.11; p = 0.401) remain similar.

Discussion

QoL was similar in both patients groups after the first postoperative week. PSA significantly reduced SSI rate. No difference was observed in incisional hernia rate, operative time, or length of hospital stay.

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Authors and Affiliations

  1. Division of General Surgery, IRCCS Policlinico San Donato, Department of Biomedical Sciences of Health, University of Milan Medical School, San Donato Milanese, Milan, Italy

    Emanuele Rausa, V. Lazzari, A. Aiolfi, G. Bonitta & L. Bonavina

  2. Department of Colorectal Surgery, Connolly Hospital, Dublin, Ireland

    M. E. Kelly

  3. Division of Surgical Oncology, Treviglio Hospital, Treviglio, Italy

    G. Sgroi

  4. Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    F. Cavalcoli

Authors
  1. Emanuele Rausa
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  2. M. E. Kelly
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  3. G. Sgroi
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  4. V. Lazzari
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  5. A. Aiolfi
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  6. F. Cavalcoli
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  7. G. Bonitta
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Correspondence to Emanuele Rausa.

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Additional information

What does this paper add to the existing literature?

This review showed that patient’s satisfaction is lower in PSA group during the first postoperative week, whereas there is no difference when compared at 1 and 6 months. SSI rate is lower in PSA, whereas incisional hernia rate, operative time, and length of hospital stay are similar between the two groups.

Paper is containing original research and has not been submitted/published earlier in any journal and is not being considered for publication elsewhere.

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Rausa, E., Kelly, M.E., Sgroi, G. et al. Quality of life following ostomy reversal with purse-string vs linear skin closure: a systematic review. Int J Colorectal Dis 34, 209–216 (2019). https://doi.org/10.1007/s00384-018-3219-z

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  • DOI: https://doi.org/10.1007/s00384-018-3219-z

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