A systematic review and Bayesian network meta-analysis of randomized controlled trials on multiple skin closure
Daichi Kitaguchi1,2, Antonello Forgione1, Chiara Innocenzi1,3
1Research Institute against Digestive Cancer (IRCAD), Strasbourg, France.
Background:
Surgical site infection (SSI) is one of the most frequent complications after stoma closure. It is associated with prolonged recovery, increased healthcare costs and impaired quality of life. Several skin closure techniques have been proposed to reduce SSI. However, most previous studies relied on pairwise comparisons, leaving uncertainty about the relative effectiveness of different approaches. This study aimed to compare skin closure methods after stoma closure using a systematic review and Bayesian network meta-analysis.
Methods:
MEDLINE (PubMed), Embase and the Cochrane Library were searched. A total of 23 randomized controlled trials enrolling 1851 adult patients who underwent stoma closure were included. Skin closure methods included linear closure, purse-string closure and gunsight closure, with or without negative pressure wound therapy or a subcutaneous drain. The primary outcome was SSI. Secondary outcomes were length of hospital stay and time to complete wound healing.
Results:
Across all studies, purse-string closure was associated with a markedly lower incidence of SSI as compared to linear closure (risk ratio: 0.18, 95% credible intervals: 0.07-0.37). No significant differences were observed between groups regarding hospital stay. However, wound healing was generally slower after purse-string closure, ranking lowest among evaluated techniques in time to complete wound healing. The overall certainty of evidence was moderate, and results were consistent across sensitivity analyses.
Conclusions:
Purse-string closure is likely to be associated with the lowest risk of SSI after stoma closure. However, it may be associated with delayed wound healing. Consequently, further refinement of this technique or the development of combination strategies is necessary to optimize both infection prevention and wound-healing outcomes.
