ABSTRACT
BACKGROUND: There is no level 1a evidence regarding the best technique for skin closure at loop ileostomy reversal. The aim of this study was to evaluate whether purse-string skin closure (PSC) is associated with lower surgical site infection (SSI) rates as compared to linear skin closure (LC). METHODS: EMBASE, MEDLINE, Pubmed, Cochrane Library, Web of Science, and CINAHL databases were systematically searched. PSC was defined as a circumferential subcuticular suture leaving a small circular skin defect allowing for free drainage, granulation, and epithelialization. In LC, the wound edges were approximated side to side with or without drainage. The primary endpoint was SSI rate. Secondary endpoints included operating time, length of hospital stay, wound healing time, and incisional hernia rates. STUDY SELECTION: Inclusion criterion was any observational or experimental study comparing PSC to LC in patients undergoing ostomy reversal. RESULTS: Twenty studies (6 experimental and 14 observational) totaling 1812 patients (826 PSC and 986 LC) were included. SSI rates were significantly lower statistically and clinically in patients with PSC [OR (95% CI) = 0.14 (0.09, 0.21); p < 0.0001; NNT = 6] in the meta-analysis of all studies. The subgroup analysis of randomized trials [OR (95% CI) = 0.10 (0.04, 0.21); p < 0.0001; NNT = 6] as well as the analysis of randomized trials including patients with loop ileostomy only [OR (95% CI) = 0.12 (0.05, 0.28); p < 0.0001; NNT = 5] confirmed this finding. CONCLUSIONS: This meta-analysis found that PSC was associated with significantly decreased rates of SSI in patients undergoing loop ileostomy reversal.
Subject(s)
Ileostomy/methods , Incisional Hernia/epidemiology , Surgical Wound Infection/epidemiology , Suture Techniques/adverse effects , Adult , Female , Humans , Incisional Hernia/etiology , Length of Stay , Male , Middle Aged , Operative Time , Surgical Wound Infection/etiology , Wound HealingABSTRACT
BACKGROUND: The aim of this systematic review and meta-analysis was to evaluate the morbidity of loop ileostomy (LI) and loop colostomy (LC) creation in restorative anterior resection for rectal cancer as well as the morbidity of their reversal. METHODS: PubMed, EMBASE, MEDLINE via Ovid, and Cochrane Library were systematically searched for records published from 1980 to 2017 by three independent researchers. The primary endpoint was overall morbidity after stoma creation and reversal. Mantel-Haenszel odds ratio (OR) was used to compare categorical variables. Clinical significance was evaluated using numbers needed to treat (NNT). RESULTS: Six studies (two randomized controlled trials and four observational studies) totaling 1063 patients (666 LI and 397 LC) were included in the meta-analysis. Overall morbidity rate after both stoma creation and closure was 15.6% in LI vs. 20.4% in LC [OR(95%CI) = 0.67 (0.29, 1.58); p = 0.36] [NNT(95%CI) = 21 (> 10.4 to benefit, > 2430.2 to harm)]. Morbidity rate after stoma creation was both statistically and clinically significantly lower after LI [18.2% vs. 30.6%; OR(95%CI) = 0.42 (0.25, 0.70); p = 0.001; NNT(95%CI) = 9 (4.7, 29.3)]. Dehydration rate was 3.1% (8/259) in LI vs. 0% (0/168) in LC. The difference was not statistically or clinically significant [OR(95%CI) = 3.00 (0.74, 12.22); p = 0.13; NNT (95%CI) = 33 (19.2, 101.9)]. Ileus rates after stoma closure were significantly higher in LI as compared to LC [5.2% vs. 1.7%; OR(95%CI) = 2.65 (1.13, 6.18); p = 0.02]. CONCLUSIONS: This meta-analysis found no difference between LI and LC in overall morbidity after stoma creation and closure. Morbidity rates following the creation of LI were significantly decreased at the cost of a risk for dehydration.
Subject(s)
Colostomy/methods , Ileostomy/methods , Postoperative Complications/physiopathology , Rectal Neoplasms/surgery , Aged , Colostomy/mortality , Disease-Free Survival , Female , Humans , Ileostomy/mortality , Male , Middle Aged , Morbidity , Observational Studies as Topic , Postoperative Complications/mortality , Prognosis , Randomized Controlled Trials as Topic , Rectal Neoplasms/diagnosis , Rectal Neoplasms/mortality , Risk Assessment , Survival Analysis , Treatment Outcome , United StatesABSTRACT
Immunological changes were examined in neonates having a different clinical status and varying effects of immunomodulation. The paper shows it expedient to use intravenous immunoglobulin as part of a package of measures to nurse premature neonates. A method for evaluating the responsiveness of immunocytes in the newborn has been developed, which is based on the determination of the equilibrium between activation-induced T-cell proliferation and apoptosis.
