Primary Linear Closure With Negative Pressure Wound Therapy Versus Purse-String Approximation After Ileostomy...

Area of Science:

• Surgical Innovation
• Wound Management
• Gastrointestinal Surgery

Background:

• Optimal wound closure after ileostomy reversal is debated.
• Pursestring approximation lowers infection rates but prolongs wound care.
• Negative pressure wound therapy (NPWT) combined with primary linear closure may improve convenience and maintain low infection rates.

Purpose of the Study:

• To compare the efficacy of primary linear closure with NPWT versus pursestring approximation for preventing surgical site infections (SSIs) after ileostomy reversal.
• To assess secondary outcomes including wound healing time and scar appearance.

Main Methods:

• A prospective, non-blinded, multi-institutional, randomized controlled trial.
• Adults undergoing elective ileostomy reversal were randomized to either primary linear closure with NPWT or pursestring approximation.
• The primary outcome was SSI, with a non-inferiority margin of 16%.

Main Results:

• Primary linear closure with NPWT was noninferior to pursestring approximation regarding SSIs (7% vs 2%).
• Significantly faster wound healing was observed with NPWT (77% healed by 2 weeks vs 23.5%).
• All wounds healed by 6 weeks in both groups, with no NPWT device malfunctions.

Conclusions:

• Primary linear closure with NPWT is a safe and effective alternative for ileostomy reversal wound closure.
• This method demonstrates noninferiority to pursestring approximation for SSIs and superior wound healing rates.
• The technique is convenient and yields cosmetically acceptable results.