Gao YB, Wang L, Shi LN, Wu X, Miao W. Impact of different skin suturing methods on patient prognosis after ileostomy closure. World J Gastrointest Surg 2025; 17(7): 106560 [DOI: 10.4240/wjgs.v17.i7.106560]
Corresponding Author of This Article
Wei Miao, Chief Physician, Professor, Department of Gastrointestinal Oncology Surgery, Affiliated Hospital of Qinghai University, No. 29 Tongren Road, Xining 810000, Qinghai Province, China. mwgg.711@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Clinical Trials Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Author contributions: Gao YB and Wang L contributed equally as co-first authors; Miao W contributed to the study concept and design, revised and reviewed the manuscript; Gao YB, Wang L, and Shi LN wrote the manuscript; Wu X collected the data; Gao YB reviewed the literature; Wang L was responsible for the data analysis and making figure; Miao W is the guarantor of this study; and all authors contributed to the article and approved the submitted version.
Institutional review board statement: The study was reviewed and approved by the Affiliated Hospital of Qinghai University Institutional Review Board (No. SL-2023170).
Clinical trial registration statement: As the author’s organization and ethics committee did not require clinical trial registration prior to the study, this study was not registered.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: The raw data supporting the conclusions of this article will be made available by the authors without undue reservation.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei Miao, Chief Physician, Professor, Department of Gastrointestinal Oncology Surgery, Affiliated Hospital of Qinghai University, No. 29 Tongren Road, Xining 810000, Qinghai Province, China. mwgg.711@163.com
Received: March 3, 2025 Revised: April 3, 2025 Accepted: May 30, 2025 Published online: July 27, 2025 Processing time: 144 Days and 21.5 Hours
Abstract
BACKGROUND
At present, prophylactic ileostomy is commonly used to protect distal intestinal anastomoses, particularly during the recovery period following colorectal surgery. However, after the ileum is returned to the abdominal cavity, abdominal closure using traditional vertical interrupted suturing is associated with a higher incidence of wound infections. For patients undergoing ileostomy closure, selecting an appropriate suturing method for the skin incision at the stoma site is crucial for improving patient prognosis.
AIM
To investigate the impact of three different skin suturing methods at the ileostomy closure site on patient prognosis.
METHODS
Thirty patients who underwent ileostomy closure at the Affiliated Hospital of Qinghai University between January 2024 and October 2024 were selected based on inclusion and exclusion criteria. The patients were divided into three groups: The purse-string suture group, the cross-suture group, and the vertical interrupted suture group, with 10 cases in each group. The purse-string suture group, cross-suture group, and vertical interrupted suture group used purse-string, cross, and vertical interrupted suturing methods, respectively, for the skin incision at the ileostomy closure site.
RESULTS
There were no statistically significant differences among the three groups in terms of operative time, intraoperative blood loss, time to resume liquid diet, time to first bowel movement, postoperative hospital stay, hospitalization costs, or levels of white blood cell count, hemoglobin, and albumin on the third postoperative day (P > 0.05). Nevertheless, significant differences (P < 0.05) were observed in incision suture removal time, wound healing time, C-reactive protein levels on the third postoperative day, visual analog scale pain scores during the first three postoperative days, and the incidence of surgical site infection. Overall, the therapeutic outcomes of the purse-string suture group and the cross-suture group were superior to the vertical interrupted suture group.
CONCLUSION
Using purse-string or cross-suturing methods for skin incision at the ileostomy closure site can shorten wound healing and suture removal times, reduce surgical site infection incidence and postoperative inflammatory response, alleviate incision pain, and promote rapid postoperative recovery.
Core Tip: For patients undergoing ileostomy closure, selecting an appropriate suturing method for the skin incision at the stoma site is crucial for improving patient prognosis. Using purse-string or cross-suturing methods for skin incision can shorten wound healing and suture removal times, reduce surgical site infection incidence and postoperative inflammatory response, alleviate incision pain, and promote rapid postoperative recovery. These two suturing methods are recommended for further clinical application.
Citation: Gao YB, Wang L, Shi LN, Wu X, Miao W. Impact of different skin suturing methods on patient prognosis after ileostomy closure. World J Gastrointest Surg 2025; 17(7): 106560
Currently, prophylactic ileostomy is commonly used to protect distal intestinal anastomoses, particularly during the recovery period following colorectal surgery[1-5]. Although the use of ileostomy during surgery does not reduce the incidence of postoperative anastomotic leakage, it can divert fecal flow when leakage occurs, thereby minimizing the severe consequences associated with anastomotic leakage. This approach can effectively alleviate patient suffering and reduce economic burden to some extent[6,7]. Nevertheless, prophylactic ileostomy not only affects patients’ quality of life but also has a significant impact on their prognosis after the second-stage closure procedure. Studies indicate that the complication rate after ileostomy closure ranges from 2% to 40%[8]. The main complications include surgical site infection (SSI, 0%-40%), intestinal obstruction (0%-13%), incisional hernia (2%-12%), and anastomotic leakage (6%)[9-14]. Clinically, vertical interrupted suturing is the most commonly used method for patients undergoing ileostomy closure. Nevertheless, after the ileum is returned to the abdominal cavity, abdominal closure using traditional vertical interrupted suturing is associated with a higher incidence of wound infections. This is likely due to contamination of the ileostomy skin by intestinal effluents[12,13]. The application of antibiotics alone has proven insufficient in preventing postoperative skin infections at the ileostomy site, often leading to delayed wound healing. In addition, when vertical interrupted suture is used, the circular stoma incision should be made into a vertical one. In this way, the skin tension at the incision site will increase, which may induce local microcirculation disorders or pull nerve endings, thus aggravating the postoperative pain of patients. However, abnormal tension of the abdominal wall is often related to factors such as fascia closure techniques and intra-abdominal pressure. This study only explores the skin level, and in the future, it can be further studied by combining fascia closure techniques with indicators such as the biomechanics of the abdominal wall biomechanics. Therefore, for patients undergoing ileostomy closure, selecting an appropriate suturing method for the skin incision at the stoma site is crucial for improving patient prognosis.
MATERIALS AND METHODS
General information
Strictly following the inclusion and exclusion criteria, 30 patients who underwent ileostomy closure at the Affiliated Hospital of Qinghai University between January 2024 and October 2024 were selected as study participants. The purse-string suture group[9-12,14,15] included 10 patients, with 4 males (40%) and 6 females (60%), and an age range of 58.20 ± 10.19 years. The cross-suture group[16,17] consisted of 10 patients, with 2 males (20%) and 8 females (80%), and an age range of 59.40 ± 8.82 years. The vertical interrupted suture group[18,19] comprised 10 patients, with 2 males (20%) and 8 females (80%), and an age range of 60 ± 14.17 years. No statistically significant differences were observed in the general baseline characteristics among the three groups (P > 0.05), indicating that the general data of the three groups were comparable.
The inclusion criteria were as followed: (1) Patients aged between 18 and 70 years; (2) Patients who previously underwent ileostomy and are undergoing ileostomy closure surgery that meets surgical indications, with surgical contraindications excluded; and (3) Patients who have not undergone any prior surgical procedures to manage the ileostomy before the ileostomy closure surgery. The exclusion criteria were as followed: (1) Patients with severe gastrointestinal complications before surgery (e.g., anastomotic leakage, severe complete intestinal obstruction) that render surgery unfeasible; (2) Patients with tumor recurrence or other malignant tumors in other organs; (3) Patients with severe systemic or stoma-related skin conditions before surgery, such as severe cardiopulmonary dysfunction precluding surgery, or stoma-site skin infections with suppuration; and (4) Patients with a documented history of neurological or psychiatric disorders that may affect study comprehension or follow-up evaluation, such as severe depression, epilepsy, or dementia.
Methods
The research methods were as followed: (1) All three groups underwent detailed medical and surgical history recording, clinical physical examinations, and routine preoperative laboratory tests and imaging studies. Preoperative colonoscopy was performed to exclude local recurrence, anastomotic leakage, or stricture, while chest, abdominal, and pelvic computed tomography scans were used to rule out distant metastases. Antibiotic usage was clearly documented for all patients, with prophylactic administration of third-generation cephalosporins 30 minutes before surgery; (2) A “single-blind” experimental design was employed to allocate patients into groups with different suturing methods at the ileostomy incision site; (3) Preoperative fasting, bowel preparation, and fluid supplementation were conducted to prevent stress responses during surgery and maintain water and electrolyte balance; and (4) All patients were given general anesthesia, and received local infiltration anesthesia with 0.5% lidocaine (dosage: 5 mg/kg) during the operation. The anesthesia protocols, drug concentrations, and injection techniques were strictly standardized across all three groups and performed by the same anesthesia team to eliminate potential confounding effects of analgesic variability on postoperative pain scores.
Operation method
Purse-string suture group: In the purse-string suture group, after the induction of general anesthesia, the surgical area was routinely disinfected, and sterile drapes were applied. A circular incision was made along the stoma site, and the ileum at the stoma site was freed layer by layer until it entered the abdominal cavity. After intraoperative exploration confirmed no abnormalities in the abdominal cavity, the ileum was pulled out through the stoma site. The ileal mesentery was freed at the intended resection site, and a disposable linear cutter stapler was used to perform a side-to-side ileo-ileal anastomosis, achieving a successful one-time firing. The stapler was used to close the stump, which was then embedded along with the anastomotic site, and the mesenteric defect was closed. The abdominal cavity was closed layer by layer. A 3-0 Monocryl (Ethicon) purse-string suture was applied subcutaneously to the stoma site incision. After tightening and knotting the suture, a residual opening of 0.3-0.5 cm in diameter remained in the skin (Figure 1A).
Figure 1 Illustration of operation method.
A: After tightening and knotting the suture, a residual opening of 0.3-0.5 cm in diameter remained in the skin; B: After tightening and knotting the suture, a residual cross-suture opening of 0.5-1 cm in diameter remained. Subsequently, 2-3 vertical interrupted sutures were applied to the skin surface with 3-0 Monocryl (Ethicon); C: After tightening and knotting the suture, a residual cross-suture opening of 0.5-1 cm in diameter remained.
Cross-suture group: In the cross-suture group, after general anesthesia induction, the surgical area was disinfected, and sterile drapes were applied. The skin elasticity around the circular stoma was assessed, and four triangular points were evenly marked around the stoma with a marker pen. The points were connected to form four triangles of roughly equal size, which were excised with a scalpel to expose the subcutaneous mucosal tissue. After completing the same surgical steps as the purse-string group and closing the abdominal cavity, a 3-0 Monocryl (Ethicon) circumferential suture was applied subcutaneously around the stoma site. After tightening and knotting the suture, a residual opening of 0.5-1 cm in diameter remained. Subsequently, 2-3 vertical interrupted sutures were applied to the skin surface with 3-0 Monocryl (Ethicon) (Figure 1B).
Vertical interrupted suture group: In the vertical interrupted suture group, after completing the same surgical steps as the purse-string group and closing the abdominal cavity, the circular stoma site incision was converted into a vertical incision. The incision was closed with 4-6 vertical interrupted sutures using 3-0 Monocryl (Ethicon) (Figure 1C).
Evaluation indicators
The evaluation indicators were as followed: (1) Intraoperative indicators: Surgical time, intraoperative blood loss; (2) Postoperative recovery indicators and visual analog scale (VAS) pain scores: Start of liquid diet, time to first bowel movement, postoperative hospital stay duration, incision suture removal time, wound healing time, hospital costs, postoperative white blood cell count, C-reactive protein (CRP), hemoglobin, and albumin levels on day 3 post-surgery, VAS pain scores for the first 3 days after surgery; and (3) Safety indicators: Postoperative complications (SSI, anastomotic leakage, intestinal obstruction, incisional hernia, pulmonary infection, suturing site leakage, mortality).
Statistical analysis
Data were analyzed using SPSS 27.0 statistical software. Quantitative data that followed a normal distribution were analyzed using analysis of variance, while data that did not follow a normal distribution were analyzed using the Kruskal-Wallis H test. For two-way unordered categorical data, the χ2-test was used, and for one-way ordered categorical data, the U test was applied. P < 0.05 was considered statistically significant. Graphic statistics were generated using GraphPad Prism 9.00 software.
RESULTS
Comparison of general data among the three groups
Comparison of the general data of the three groups revealed no statistically significant differences (P > 0.05, Tables 1 and 2).
Table 1 Comparison of general data among the three groups, n (%).
Purse-string suture group
Cross-suture group
Vertical interrupted suture group
P value
Cases
10
10
10
Comorbidities
0.672
None
9 (90.00)
7 (70.00)
6 (60.00)
Hypertension
1 (10.00)
2 (20.00)
2 (20.00)
Diabetes
0 (0.00)
1 (10.00)
1 (10.00)
Coronary artery disease
0 (0.00)
0 (0.00)
1 (10.00)
Primary disease
0.986
Colon cancer
3 (30.00)
2 (20.00)
3 (30.00)
Rectal cancer
6 (60.00)
7 (70.00)
6 (60.00)
Intestinal obstruction
1 (10.00)
1 (10.00)
1 (10.00)
Gender
0.171
Male
4 (40.00)
8 (80.00)
8 (80.00)
Female
6 (60.00)
2 (20.00)
2 (20.00)
Table 2 Comparison of general data among the three groups, mean ± SD.
Purse-string suture group
Cross-suture group
Vertical interrupted suture group
P value
Cases
10
10
10
Age, years
58.20 ± 10.19
59.40 ± 8.82
60.00 ± 14.17
0.876
Height, m
1.64 ± 0.08
1.65 ± 0.07
1.64 ± 0.10
0.940
Weight, kg
56.65 ± 6.62
60.10 ± 6.98
60.90 ± 8.33
0.402
BMI, kg/m2
21.01 ± 1.90
21.87 ± 1.56
22.45 ± 2.52
0.298
Preoperative albumin level, g/L
41.23 ± 3.65
41.48 ± 2.93
42.13 ± 3.68
0.834
Time interval before reversal, months
6.40 ± 2.50
5.60 ± 2.27
6.30 ± 1.88
0.687
Comparison of intraoperative indicators, postoperative recovery indicators, and postoperative VAS pain scores among the three groups
Analysis of intraoperative indicators and postoperative recovery metrics revealed no statistically significant differences between the three groups in terms of surgical time, intraoperative blood loss, time to start liquid diet, time to first bowel movement, postoperative hospital stay, hospital costs, and white blood cell count, hemoglobin levels, and albumin levels on day 3 post-surgery (P > 0.05). Nevertheless, statistical differences were observed between the three groups in terms of incision suture removal time, wound healing time, CRP levels on day 3 post-surgery, and VAS pain scores for the first 3 days after surgery (P < 0.05, Tables 3, 4, and 5, Figure 2).
Figure 2 Comparison of intraoperative indicators, postoperative recovery indicators, and postoperative visual analog scale pain scores among the three groups.
A: Wound healing time among three groups, compared with the traditional vertical interrupted suture, cross-stitch suturing and purse-string can shorten the healing time; B: Suture removal time among three groups, compared with the traditional vertical interrupted suture, cross-stitch suturing and purse-string can shorten the suture removal time; C: C-reactive protein levels on day 3 post-surgery among three groups, compared with the traditional vertical interrupted suture, cross-stitch suturing and purse-string have lower C-reactive protein levels; D: Postoperative visual analog scale pain scores among three groups, compared with the traditional vertical interrupted suture, cross-stitch suturing and purse-string have mild pain.
Table 3 Comparison of intraoperative and postoperative recovery indicators among the three groups, M (QL-QU).
Purse-string suture group
Cross-suture group
Vertical interrupted suture group
P value
Cases
10
10
10
Surgical time, minutes
53.00 (50.00-56.25)
59.00 (53.75-67.00)
60.00 (55.25-67.00)
0.107
Intraoperative blood loss, mL
21.00 (18.75-35.00)
20.00 (20.00-50.00)
22.50 (20.00-42.50)
0.588
Time to start liquid diet, days
3.00 (3.00-4.25)
3.00 (3.00-3.00)
3.50 (3.00-5.00)
0.061
Time to first bowel movement, days
3.00 (2.75-3.00)
3.00 (3.00-3.00)
3.00 (3.00-3.00)
0.850
Postoperative hospitalization duration, days
8.00 (6.75-10.00)
7.00 (6.25-9.00)
7.00 (6.00-8.50)
0.082
Suture removal time, days
7.00 (6.00-8.00)
7.00 (7.00-7.00)
7.00 (7.00-8.50)
0.004
Wound healing time, days
21.00 (20.00-22.00)
21.00 (19.00-22.00)
24.00 (23.00-27.25)
0.002
Hospitalization costs, CNY
38792.50 (34118.25-43267.25)
37503.00 (33699.25-40873.50)
38645.00 (33237.75-42444.75)
0.756
Table 4 Comparison of postoperative recovery indicators among the three groups, M (QL-QU).
Purse-string suture group
Cross-suture group
Vertical interrupted suture group
P value
Cases
10
10
10
Postoperative white blood cell count, 109/L
6.7950 (5.7675-7.6050)
5.9150 (5.0250-7.1750)
6.0050 (4.5525-7.5900)
0.477
Postoperative CRP level, mg/L
30.5000 (25.0000-37.7500)
37.0000 (26.0000-42.0000)
58.0000 (50.0000-70.0000)
0.000
Postoperative hemoglobin level, g/L
109.5000 (89.7500-132.0000)
113.5000 (103.0000-120.7500)
112.0000 (97.2500-120.7500)
0.935
Postoperative albumin level, g/L
37.5000 (34.7500-41.0000)
35.6000 (34.0000-37.0000)
35.5000 (33.7500-37.2500)
0.290
Table 5 Comparison of postoperative visual analog scale pain scores among the three groups, mean ± SD.
Purse-string suture group
Cross-suture group
Vertical interrupted suture group
P value
Cases
10
10
10
12 hours post-surgery
4.00 ± 0.47
4.10 ± 0.31
5.40 ± 0.69
0.000
1 day post-surgery
3.50 ± 0.52
3.20 ± 0.42
4.80 ± 0.63
0.000
2 days post-surgery
3.30 ± 0.48
2.90 ± 0.31
4.10 ± 0.56
0.000
3 days post-surgery
2.60 ± 0.51
2.40 ± 0.51
3.30 ± 0.48
0.000
Comparison of postoperative safety indicators among the three groups
The postoperative complications of the three groups were classified according to the Clavien-Dindo classification, all falling within grade I-II. All patients received symptomatic conservative treatment and fully recovered, with no cases requiring surgical intervention or resulting in death. Analysis revealed that no patients in the purse-string suture group or the cross-suture group developed SSI, and the incidence of this postoperative complication was significantly lower in these two groups compared to the vertical interrupted suture group. This difference was statistically significant (P < 0.05). All three groups experienced pulmonary infections and suturing site leakage postoperatively. Nevertheless, all patients with these complications were conservatively treated and recovered. Comparison of the incidence of pulmonary infections and suturing site leakage revealed no statistically significant differences between the three groups (P > 0.05). In the vertical interrupted suture group, one patient developed postoperative intestinal obstruction (which was treated conservatively). Nevertheless, this difference was not statistically significant (P > 0.05). Since no cases of anastomotic leakage, incisional hernia, or death occurred in any of the three groups, further analysis and conclusions could not be drawn regarding these complications (Table 6).
Table 6 Comparison of postoperative safety indicators among the three groups, n (%).
Purse-string suture group
Cross-suture group
Vertical interrupted suture group
P value
Cases
10
10
10
SSI
0
0
4 (40.00)
0.010
Anastomotic leak
0
0
0
-
Intestinal obstruction
0
0
1 (10.00)
0.355
Incisional hernia
0
0
0
-
Pulmonary infection
2 (20.00)
1 (10.00)
2 (20.00)
0.535
Suture site bleeding
2 (20.00)
2 (20.00)
3 (30.00)
0.830
Death
0
0
0
-
DISCUSSION
No unexpected events occurred during the surgical procedures for all three groups, and no deaths were observed during or after surgery. Analysis of intraoperative indicators, postoperative recovery metrics, VAS pain scores, and postoperative safety indicators showed that there were no statistically significant differences in surgical time, intraoperative blood loss, time to start liquid diet, time to first bowel movement, postoperative hospital stay, total hospital costs, or white blood cell count, hemoglobin levels, and albumin levels on the third postoperative day (P > 0.05). This suggests that using either the purse-string suture or cross-suture technique for skin closure at the ileostomy site is just as straightforward and effective as the traditional vertical interrupted suture technique, and does not increase the difficulty, risk, or trauma associated with surgery, nor does it impose a greater economic burden on patients. Further comparative analysis revealed that the purse-string and cross-suture groups performed better than the vertical interrupted suture group in terms of incision suture removal time, wound healing time, CRP levels on the third postoperative day, and VAS pain scores for the first three days after surgery (P < 0.05). This indicates that the purse-string and cross-suture techniques are more effective than the vertical interrupted technique in reducing skin tension at the incision site, promoting wound healing, and alleviating postoperative pain. Although 4 patients in the vertical interrupted suture group developed SSI, all the incisions in the surgical area of the patients achieved complete healing due to timely detection and active treatment (complete wound healing is defined as meeting the following criteria simultaneously: (1) There is no exudate, redness or fluctuating tenderness at the incision; (2) The continuity of the epidermis is intact; and (3) There is no deep tissue separation or induration upon palpation by the doctor). The incisions in the surgical areas of the patients in the other two groups also achieved complete healing. In this study, the median time for suture removal of the postoperative incisions in the three groups of patients was 7 days. Why did such similar results occur? The reasons may be as follows: (1) The postoperative incision healing of the patients in the three groups all reached primary healing; and (2) Based on the condition of primary incision healing, our institution routinely adopts the strategy of early intervention for suture removal of incisions with low tension in clinical practice, aiming to reduce the risk of suture indentation on the incisions. This not only further reduces the impact of sutures on skin cosmetology, but also further affects the time of suture removal after the operation. Notwithstanding the study did not find significant differences in surgical time or intraoperative blood loss among the three groups (P > 0.05), there were statistically significant differences in the incidence of SSI (P < 0.05). The occurrence of SSI may have a significant impact on postoperative hospital stay, wound healing time, and suture removal time. Our study also found no statistically significant differences in total hospital costs between the groups (P > 0.05), but the vertical interrupted suture group with SSI had higher hospital costs compared to the other two groups without SSI. This is likely due to the early detection and relatively mild infections, which were treated promptly. Although there were no significant differences in total hospital costs between the groups, the results suggest that the purse-string and cross-suture techniques can reduce the incidence of SSI, which in turn promotes faster recovery and better postoperative outcomes. Since the sample size in this study was relatively small, there may not have been enough statistical power to detect small differences in outcomes. No cases of anastomotic leakage, incisional hernia, or death occurred in any of the three groups, and no SSI cases were observed in the purse-string or cross-suture groups. Nevertheless, the results of this study provide evidence of the advantages of the purse-string and cross-suture techniques, suggesting that they may be worth promoting for clinical use in the future.
Notwithstanding there are various methods for suturing the skin incision at the ileostomy site, past techniques have aimed to minimize the incidence of SSI after suturing. While leaving the incision completely open and ensuring adequate drainage could potentially reduce the occurrence of SSI, it results in a prolonged healing time due to secondary intention, which is much longer than primary healing. Additionally, this method can lead to unsightly scarring that may negatively impact the patient’s self-esteem. Another alternative is the use of subcutaneous drainage tubes to facilitate smooth drainage, potentially reducing the likelihood of SSI[20]. Nevertheless, this method increases postoperative nursing costs. The purse-string suture technique combines the principles of the aforementioned two approaches, promoting wound healing. In fact, the purse-string suture does not fully close the incision but rather constricts the wound, leaving a small skin defect of about 0.5-1 cm in diameter at the center of the incision. This defect allows for adequate drainage of exudates during the early postoperative period, thus reducing the occurrence of SSI and promoting wound healing. The research data results show[21,22] that purse-string suture reduces the risk of SSI at the skin incision after ileostomy closure. Further analysis of the reasons shows that there are pathogenic microorganisms causing incision infection on the skin around the stoma site. Due to the relatively fast healing speed of superficial skin tissues, in the past, with the vertical interrupted suture method, the exudate containing pathogenic microorganisms in the surgical area incision was not easy to drain, resulting in SSI. SSI triggers a large number of neutrophils and macrophages to infiltrate locally, releasing anti-inflammatory factors, disrupting the microenvironment required for normal healing, delaying the healing of the incision, and possibly inducing adverse events such as abscess formation and incision dehiscence. In this case, the healing time of the incision is further prolonged, which not only increases the investment cost of medical treatment and nursing, but also further increases the negative emotions of patients. From a cosmetic perspective, the central defect left by the purse-string suture is effectively covered by granulation tissue, improving the aesthetic appearance of the incision site postoperatively[22-24].
The cross-suture technique is a novel suturing method that has demonstrated significant advantages across various surgical procedures. When applied to stoma reversal surgery, it offers a simple surgical technique with excellent cosmetic results and a reduction in postoperative SSI rates. This technique enhances exposure of the surgical field, minimizing the risk of accidental injury to the intestinal tract due to inadequate exposure. Previous research results[25] show that compared with the traditional vertical interrupted suture, cross-stitch suturing has lower incision tension and can shorten the healing time. Nevertheless, there is still debate regarding which specific suturing method can most effectively reduce the incidence of SSI and other postoperative complications[26-28]. While acknowledging the critical role of underlying comorbidities in wound healing, subsequent phases of this study will standardize patient inclusion criteria by selecting individuals with identical baseline pathologies, thereby controlling for potential confounders. Nonetheless, it is expected that as research in this area expands, the findings will become more representative and provide more valuable clinical guidance, ultimately benefiting a greater number of patients.
CONCLUSION
The use of pouch or cross suturing techniques for the skin incision in stoma reversal surgery can shorten the postoperative wound healing time, reduce suture removal time, lower the incidence of SSI, mitigate postoperative inflammatory responses, and alleviate incision pain. These benefits collectively promote faster postoperative recovery for patients. Both suturing methods are worthy of further clinical promotion and application. Although the sample size in this study was small, the findings provide valuable insights and serve as a reference for future prospective, randomized, large-sample studies.
ACKNOWLEDGEMENTS
We acknowledge and appreciate our colleagues for their valuable suggestions and technical assistance with this study.
Footnotes
Provenance and peer review: Unsolicited article; Externally peer reviewed.
Peer-review model: Single blind
Specialty type: Gastroenterology and hepatology
Country of origin: China
Peer-review report’s classification
Scientific Quality: Grade B
Novelty: Grade B
Creativity or Innovation: Grade C
Scientific Significance: Grade B
P-Reviewer: Ortega-Goddard E S-Editor: Wei YF L-Editor: A P-Editor: Zhang XD
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