Efficacy comparison of purse-string vs. linear closure of the wound following stoma reversal: systematic review and meta-analysis / 中华胃肠外科杂志

ABSTRACT

Objective@#To compare the efficacy of purse-string skin closure (PSC) and linear skin closure (LSC) in stoma reversal.@*Methods@#Randomized controlled trials (RCT) comparing the use of PSC and LSC during stoma reversal were searched from Embase, PubMed, Web of Science, CNKI net, Wanfang database, VIP Chinese Science and Technology Journal Database. Literature inclusion criteria (1) randomized controlled trials about comparing PSC and LSC in stoma reversal published publicly; only including English literature; (2) patients undergoing stoma (ileostomy or colostomy) reversal without limitation of age, sex and ethnicity; (3) PSC group receiving the suture of the dermis layer of the skin by purse-string suture, and forming a pore channel in the center of the skin after tightening and knotting, in order to achieve the purpose of secondary healing; the LSC group receiving the suture of the skin with conventional simple interrupted suture; (4) the enrolled literatures needed to include at least one of the following outcome indicators the primary outcome was the incidence of SSI; the secondary outcome included the operation time, incisional hernia, hospital stay and patient satisfaction. Literature exclusion criteria (1) duplicate published studies, incomplete studies, reviews, case reports, unpublished literature, retrospective studies, non-RCT. The search time ended on November 15, 2018. The basic information and important outcome indicators of the included articles were extracted. The Cochrane bias risk assessment tool was used to evaluate the quality of the selected literatures. Patient satisfaction was assessed using the following scales (1) the patient and observer scar assessment scale (POSAS); (2) the body image questionnaire (BIQ); (3) Likert scale; (4) short form 36 (SF-36), version 2; (5) visual analog scale (VAS). Meta-analysis was performed using Review manager 5.3 software provided by the Cochrane Collaboration.@*Results@#A total of 9 randomized controlled trials were included, involving 806 patients with 411 cases in the PSC group and 395 cases in the LSC group. Baseline data such as age, gender, body mass index (BMI), underlying disease, and anesthesia grading were not significantly different between the two groups (all P>0.05). The quality of these nine randomized controlled trials was high. Because the evaluation methods for these studies are not uniform, it is impossible to conduct a meta-analysis of patient satisfaction. However, from the summary results of various studies, the postoperative satisfaction of the purse-string suture group was better than that of the linear suture group. The meta-analysis showed that there was significant difference in postoperative SSI incidence between the PSC group and the LSC group [OR=0.14, 95%CI 0.08-0.24, P<0.00001], while there were no significant differences in incidence of incisional hernia [OR=0.66, 95%CI 0.24-1.82, P=0.42], operation time [MD=0.61, 95%CI -3.17-4.38, P=0.75], and hospital stay [MD=-0.26, 95%CI -0.82-0.30, P=0.37].@*Conclusions@#PSC can be used for closure of the wound following stoma reversal. Compared with LSC, PSC can significantly reduce the incidence of SSI, and increase patients′ satisfaction.