Conventional Linear versus Purse-string Skin Closure after Loop Ileostomy Reversal: Comparison of Wound Infection Rates and Operative Outcomes

PURPOSE: Wound infection after an ileostomy reversal is a common problem. To reduce wound-related complications, purse-string skin closure was introduced as an alternative to conventional linear skin closure. This study is designed to compare wound infection rates and operative outcomes between linear and purse-string skin closure after a loop ileostomy reversal. METHODS: Between December 2002 and October 2010, a total of 48 consecutive patients undergoing a loop ileostomy reversal were enrolled. Outcomes were compared between linear skin closure (group L, n = 30) and purse string closure (group P, n = 18). The operative technique for linear skin closure consisted of an elliptical incision around the stoma, with mobilization, and anastomosis of the ileum. The rectus fascia was repaired with interrupted sutures. Skin closure was performed with vertical mattress interrupted sutures. Purse-string skin closure consisted of a circumstomal incision around the ileostomy using the same procedures as used for the ileum. Fascial closure was identical to linear closure, but the circumstomal skin incision was approximated using a purse-string subcuticular suture (2-0 Polysorb). RESULTS: Between group L and P, there were no differences of age, gender, body mass index, and American Society of Anesthesiologists (ASA) scores. Original indication for ileostomy was 23 cases of malignancy (76.7%) in group L, and 13 cases of malignancy (77.2%) in group P. The median time duration from ileostomy to reversal was 4.0 months (range, 0.6 to 55.7 months) in group L and 4.1 months (range, 2.2 to 43.9 months) in group P. The median operative time was 103 minutes (range, 45 to 260 minutes) in group L and 100 minutes (range, 30 to 185 minutes) in group P. The median hospital stay was 11 days (range, 5 to 4 days) in group L and 7 days (range, 4 to 14 days) in group P (P < 0.001). Wound infection was found in 5 cases (16.7%) in group L and in one case (5.6%) in group L (P = 0.26). CONCLUSION: Based on this study, purse-string skin closure after a loop ileostomy reversal showed comparable outcomes, in terms of wound infection rates, to those of linear skin closure. Thus, purse-string skin closure could be a good alternative to the conventional linear closure.

Management of Cecal Diverticulitis

PURPOSE: Diverticular disease of the cecum and ascending colon is a relatively uncommon disease, and is often difficult to diagnose. The purpose of this study was to investigate the clinical features of patients who underwent surgical treatment for cecal diverticulitis. METHODS: A retrospective review was conducted between January 1998 and December 2002 of 44 patients treated at the Department of Surgery, Soonchunghyang Gumi Hospital. RESULTS: All patients presented with right lower quadrant pain and tenderness. Preoperatively, 34 patients were diagnosed with acute appendicitis. The surgical procedures for cecal diverticulitis were an appendectomy only (5 cases), a diverticulectomy with appendectomy (31 cases), and a right hemicolectomy (8 cases). Postoperative complications were found in 17 cases: wound infection (13 cases), and partial intestinal obstruction (2 cases). CONCLUSIONS: When cecal diverticulitis is found at the time of an operation, surgical management is a safe treatment with low morbidity and a low recurrence rate. A diverticulectomy with appendectomy is a safe and effective procedure for the treatment of cecal diverticulitis if there is no evidence of free perforation or abscess formation. If the diverticulitis is complicated, undistinguishable from a malignancy, a resection (ileocecal resection, right hemicolectomy) should be considered for the surgical treatment.