Quality of life following ostomy reversal with purse-string vs linear skin closure: a systematic review

Emanuele Rausa, M. E. Kelly, G. Sgroi, V. Lazzari, A. Aiolfi, F. Cavalcoli, G. Bonitta, L. Bonavina

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Background: The importance of the defunctioning stoma on minimizing anastomotic leak in colorectal surgery is well established. However, a defunctioning stoma can substantially impact on quality of life (QoL). Circumferential purse-string approximation (PSA) and linear skin closure (LSC) are the most commonly performed surgical technique for reversal of stoma. The aim of this review was to systemically review and meta-analyze available randomized controlled trials (RCTs) comparing PSA and LSC. Methods: An electronic systematic search using MEDLINE databases (PubMed, EMBASE, and Web of Science) of RCTs comparing PSA and LSC was performed. Eight RCTs totalling 647 patients met the inclusion criteria and were included in this meta-analysis. Results: Patient’s satisfaction is significantly lower in PSA group during the first postoperative week, but it sharply improves afterwards and no difference were noted at 1 and 6 months between the two groups. Relative risk (RR) of developing a SSI is significantly lower in PSA compared to LSC group (RR 0.16 95% CI 0.09; 0.30; p = 0.0001), whereas incisional hernia (RR 0.53 95% CI 0.08; 3.53; p = 0.512), operative time (MD − 0.06 95% CI − 0.30; 0.17; p = 0.593), and hospital stay (MD − 0.09 (95% CI − 0.29-0.11; p = 0.401) remain similar. Discussion: QoL was similar in both patients groups after the first postoperative week. PSA significantly reduced SSI rate. No difference was observed in incisional hernia rate, operative time, or length of hospital stay.

Original languageEnglish
Pages (from-to)209-216
Number of pages8
JournalInternational Journal of Colorectal Disease
Volume34
Issue number2
DOIs
Publication statusPublished - Feb 6 2019

Fingerprint

Ostomy
Quality of Life
Length of Stay
Skin
Randomized Controlled Trials
Operative Time
Meta-Analysis
Colorectal Surgery
Anastomotic Leak
Patient Satisfaction
PubMed
MEDLINE
Databases
Incisional Hernia

Keywords

  • Incisional hernia
  • Ostomy reversal
  • Scar cosmesis
  • Surgical site infection

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Quality of life following ostomy reversal with purse-string vs linear skin closure : a systematic review. / Rausa, Emanuele; Kelly, M. E.; Sgroi, G.; Lazzari, V.; Aiolfi, A.; Cavalcoli, F.; Bonitta, G.; Bonavina, L.

In: International Journal of Colorectal Disease, Vol. 34, No. 2, 06.02.2019, p. 209-216.

Research output: Contribution to journalReview article

Rausa, Emanuele ; Kelly, M. E. ; Sgroi, G. ; Lazzari, V. ; Aiolfi, A. ; Cavalcoli, F. ; Bonitta, G. ; Bonavina, L. / Quality of life following ostomy reversal with purse-string vs linear skin closure : a systematic review. In: International Journal of Colorectal Disease. 2019 ; Vol. 34, No. 2. pp. 209-216.
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abstract = "Background: The importance of the defunctioning stoma on minimizing anastomotic leak in colorectal surgery is well established. However, a defunctioning stoma can substantially impact on quality of life (QoL). Circumferential purse-string approximation (PSA) and linear skin closure (LSC) are the most commonly performed surgical technique for reversal of stoma. The aim of this review was to systemically review and meta-analyze available randomized controlled trials (RCTs) comparing PSA and LSC. Methods: An electronic systematic search using MEDLINE databases (PubMed, EMBASE, and Web of Science) of RCTs comparing PSA and LSC was performed. Eight RCTs totalling 647 patients met the inclusion criteria and were included in this meta-analysis. Results: Patient’s satisfaction is significantly lower in PSA group during the first postoperative week, but it sharply improves afterwards and no difference were noted at 1 and 6 months between the two groups. Relative risk (RR) of developing a SSI is significantly lower in PSA compared to LSC group (RR 0.16 95{\%} CI 0.09; 0.30; p = 0.0001), whereas incisional hernia (RR 0.53 95{\%} CI 0.08; 3.53; p = 0.512), operative time (MD − 0.06 95{\%} CI − 0.30; 0.17; p = 0.593), and hospital stay (MD − 0.09 (95{\%} CI − 0.29-0.11; p = 0.401) remain similar. Discussion: QoL was similar in both patients groups after the first postoperative week. PSA significantly reduced SSI rate. No difference was observed in incisional hernia rate, operative time, or length of hospital stay.",
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T1 - Quality of life following ostomy reversal with purse-string vs linear skin closure

T2 - a systematic review

AU - Rausa, Emanuele

AU - Kelly, M. E.

AU - Sgroi, G.

AU - Lazzari, V.

AU - Aiolfi, A.

AU - Cavalcoli, F.

AU - Bonitta, G.

AU - Bonavina, L.

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AB - Background: The importance of the defunctioning stoma on minimizing anastomotic leak in colorectal surgery is well established. However, a defunctioning stoma can substantially impact on quality of life (QoL). Circumferential purse-string approximation (PSA) and linear skin closure (LSC) are the most commonly performed surgical technique for reversal of stoma. The aim of this review was to systemically review and meta-analyze available randomized controlled trials (RCTs) comparing PSA and LSC. Methods: An electronic systematic search using MEDLINE databases (PubMed, EMBASE, and Web of Science) of RCTs comparing PSA and LSC was performed. Eight RCTs totalling 647 patients met the inclusion criteria and were included in this meta-analysis. Results: Patient’s satisfaction is significantly lower in PSA group during the first postoperative week, but it sharply improves afterwards and no difference were noted at 1 and 6 months between the two groups. Relative risk (RR) of developing a SSI is significantly lower in PSA compared to LSC group (RR 0.16 95% CI 0.09; 0.30; p = 0.0001), whereas incisional hernia (RR 0.53 95% CI 0.08; 3.53; p = 0.512), operative time (MD − 0.06 95% CI − 0.30; 0.17; p = 0.593), and hospital stay (MD − 0.09 (95% CI − 0.29-0.11; p = 0.401) remain similar. Discussion: QoL was similar in both patients groups after the first postoperative week. PSA significantly reduced SSI rate. No difference was observed in incisional hernia rate, operative time, or length of hospital stay.

KW - Incisional hernia

KW - Ostomy reversal

KW - Scar cosmesis

KW - Surgical site infection

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