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Purse-string approximation vs. primary closure with a drain for stoma reversal surgery: results of a randomized clinical trial

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Abstract

Purpose

Stoma reversal carries a risk of surgical site infection (SSI). Purse-string approximation (PSA) has been reported as an attractive alternative to conventional primary wound closure for stoma reversal, but its efficacy is still under debate.

Methods

Patients undergoing elective stoma reversal were randomized to undergo PSA or primary closure with a drain (PCD). All patients received preoperative bowel cleansing and antimicrobial prophylaxis. The primary endpoint was the incidence of wound healing at the stoma site 30 days after surgery. The secondary endpoint was the 30-day SSI rate after surgery.

Results

A total of 159 patients (PCD group, n = 79; PSA group, n = 80) were eligible for this study. The incidence of wound healing at the stoma site was 92.4% in the PCD group and 62.5% in the PSA group [difference (95% confidence interval − 29.9% (− 42.9 to − 16.9%)]. The 30-day SSI rate at the stoma site, as the secondary endpoint, was 8.9% in the PCD group and 5.0% in the PSA group (P = 0.35).

Conclusions

These results suggest that PCD may remain the standard procedure for stoma reversal surgery.

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Acknowledgements

We thank Professor Tomoyuki Kawada, Department of Public Health, Nippon Medical School, for his valuable assistance with the statistical analysis.

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Authors and Affiliations

  1. Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan

    Kunihiko Amamo, Hideyuki Ishida, Kensuke Kumamoto, Norimichi Okada, Satoshi Hatano, Noriyasu Chika, Yusuke Tajima, Tomonori Ohsawa, Masaru Yokoyama, Keiichiro Ishibashi & Erito Mochiki

  2. Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Miki-cho, Kagawa, Japan

    Kensuke Kumamoto

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  1. Kunihiko Amamo
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  2. Hideyuki Ishida
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Correspondence to Kensuke Kumamoto.

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Amamo, K., Ishida, H., Kumamoto, K. et al. Purse-string approximation vs. primary closure with a drain for stoma reversal surgery: results of a randomized clinical trial. Surg Today 49, 231–237 (2019). https://doi.org/10.1007/s00595-018-1729-5

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  • DOI: https://doi.org/10.1007/s00595-018-1729-5

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