Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 Apr 5;29(1):93.
doi: 10.1007/s10151-025-03135-1.

Circular (purse-string) vs primary skin closure following stoma closure: an up-to-date systematic review and meta-analysis

F Menegon Tasselli #  1 , F Pata #  2 , G Fuschillo  1 , G Signoriello  3 , A Bondurri  4 , G Sciaudone  5 , F Selvaggi  6 , G Pellino  7   8
Affiliations
Meta-Analysis

Circular (purse-string) vs primary skin closure following stoma closure: an up-to-date systematic review and meta-analysis

F Menegon Tasselli et al. Tech Coloproctol. .

Abstract

Background: Surgical site infections (SSI) are the most common complication after stoma closure. Circular skin closure (CSC) has been proposed to reduce SSI with comparable or even better outcomes than conventional primary sutures (PS). The aim of this meta-analysis is to compare circular with primary skin closure in stoma closure.

Method: A systematic review of the literature was performed for articles published between January 2010 and June 2023, including all randomized control trials (RCT) on wound infection of adult patients following stoma reversal. The primary outcome was 30-day SSI; secondary outcomes were operative time, length of stay, and incisional hernia.

Results: Eight RCTs were identified that included a total of 606 patients undergoing stoma closure surgery. Four percent of patients in the CSC group developed SSI, compared to 27% of patients undergoing PS. The 30-day SSI rate was lower after the circular skin closure (OR 0.11, 95% CI 0.06-0.21; p < 0.00001, I2 = 0%). There was no difference in the operative time (99.2 vs 103.5 min; MD - 0.17, 95% CI - 0.37, 0.03; p = 0.10), length of stay (7.1 vs 7.7 days; MD - 0.34, 95% CI - 0.55, - 0.12; p = 0.002), and incisional hernia rate (2% vs 4%; OR 0.61, 95% CI 0.23, 1.60; p = 0.31).

Conclusion: CSC is associated with lower SSI rate and should be preferred to linear skin closure technique after stoma closure surgery.

Keywords: Ostomy closure; Postoperative complications; Skin closure; Surgical wound infection.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests. Ethical and Informed consent: The authors did not perform any procedure on patients in this study.

Figures

Fig. 1
Fig. 1
Flowchart of study selection according to PRISMA statement
Fig. 2
Fig. 2
Meta-analysis of risk of SSI
Fig. 3
Fig. 3
Meta-analysis of operative time
Fig. 4
Fig. 4
Meta-analysis of LOS
Fig. 5
Fig. 5
Meta-analysis of incisional hernia
Fig. 6
Fig. 6
Risk of bias according to RoB2 tool
See this image and copyright information in PMC

References

    1. Force OGT, Goldberg M, Aukett LK et al (2010) Management of the patient with a fecal ostomy: best practice guideline for clinicians. J Wound Ostomy Continence Nurs 37(6):596–598. 10.1097/WON.0b013e3181f97e37 - DOI - PubMed
    1. Hackam DJ, Rotstein OD (1995) Stoma closure and wound infection: an evaluation of risk factors. Can J Surg 38(2):144–148 - PubMed
    1. Avsar P, Patton D, Ousey K, Blackburn J, O’Connor T, Moore Z (2021) The impact of surgical site infection on health-related quality of life: a systematic review. Wound Manag Prev 67(6):10–19 - DOI - PubMed
    1. Badia JM, Casey AL, Petrosillo N, Hudson PM, Mitchell SA, Crosby C (2017) Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries. J Hosp Infect 96(1):1–15. 10.1016/j.jhin.2017.03.004 - DOI - PubMed
    1. Banerjee A (1997) Pursestring skin closure after stoma reversal. Dis Colon Rectum 40(8):993–994 - DOI - PubMed

LinkOut - more resources