Outcome of colostomy closure with different skin closure techniques in a developing country
R M Shukla1, B B Tripathy, B Mukhopadhyay
1Department of Paediatric Surgery, Nil Ratan Sircar Medical College and Hospital, Kolkata, India. rammohanshukla@yahoo.co.in
Insights
Closing colostomies without drains and using subcuticular skin closure offers better cosmetic outcomes without increasing wound infection or anastomotic leak risks in pediatric patients.
Area of Science:
- Pediatric Surgery
- Wound Healing
- Surgical Outcomes
Background:
- Colostomy sites are considered contaminated wounds.
- Traditional closure involves interrupted stitches and drains, often leading to poor cosmetic results.
- This study prospectively evaluates different colostomy closure techniques.
Purpose of the Study:
- To compare the outcomes of colostomy closure with and without drains and different skin closure methods.
- To assess wound infection, anastomotic leaks, and cosmetic results.
- To determine the optimal technique for pediatric colostomy closure.
Main Methods:
- Prospective study of 151 pediatric patients undergoing colostomy closure (August 2006 - February 2008).
- Group A: No drains, subcuticular skin closure. Group B: Intraperitoneal and parietal drains, interrupted skin closure.
- Data collected included patient demographics, diagnosis, wound infection, anastomotic leaks, and follow-up assessments.
Main Results:
- No statistically significant difference in wound infection rates between Group A and Group B.
- No statistically significant difference in anastomotic leak rates between Group A and Group B.
- Significantly better cosmetic outcomes were observed in Group A (no drain, subcuticular closure).
Conclusions:
- Colostomy closure without drains and with subcuticular skin closure is safe.
- This technique does not increase the incidence of wound infection or anastomotic leaks.
- The no-drain, subcuticular closure method yields superior cosmetic results in pediatric patients.
Background:
Colostomy site, which is a potentially contaminated wound, is traditionally closed with interrupted skin stitches and placement of intraperitoneal or parietal or both drains; often with poor cosmetic outcome in our country. This study aims at prospective evaluation of colostomy closure wounds by different techniques.
Patients And Methods:
This study was carried out in all infants and children with colostomy (for different pathologies) admitted for colostomy closure in our institute from August 1, 2006 to February 29, 2008. Patients were divided into two groups: Group A with colostomy closure without any drain and subcuticular skin closure and Group B with colostomy closure with both intraperitoneal and parietal drain and interrupted skin closure. Patient's details, including age, sex, body weight, diagnosis, preoperative bowel preparation, peroperative antibiotics, postoperative wound infection, anastomotic leaks, duration of hospitalisation and postoperative follow-up for wound assessment, were recorded. By the end of February 2008, 151 cases of colostomy closure were recorded, 70 in Group A and 81 in Group B.
Results:
Statistical analysis of the data showed no statistically significant difference in wound infection and anastomotic leak between the two groups. On postoperative follow-up, wound assessment showed significantly better cosmesis in the no drain subcuticular group.
Conclusion:
This study shows that closing colostomies without any drain and subcuticular skin closure does not result in any increased incidence of wound infection and has better cosmetic results.
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