Habbe Nils, Hannes Sabine, Liese Juliane, Woeste Guido, Bechstein Wolf Otto, Strey Christoph
Department of General and Visceral Surgery, Hospital of the Johann Wolfgang Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany,
Int J Colorectal Dis. 2014 Jun;29(6):709-14. doi: 10.1007/s00384-013-1822-6. Epub 2014 Jan 10.
Wound infections affect not only the individual patient but lead to an increase in medical costs. After ileostomy reversal, surgical site infections are a common problem. The objective of the study was to compare the infection rates of purse-string and conventional skin closure techniques in a high volume setting.
Patients undergoing ileostomy reversal at the Goethe University Hospital between January 2009 and August 2012 were retrospectively analysed regarding surgical site infections and associated risk factors. Patients received either conventional skin closure (running, interrupted or stapled suturing; group C) or subcuticular purse-string suture (group PS).
In total, 114 patients have been analysed. Conventional wound closure was performed in 81 patients and 33 patients received purse-string skin closure. The groups did not differ regarding age, gender, indication for ileostomy, previous chemotherapy, and operation time. Median hospital stay was 7 days (3-34) in group PS and 8 (3-53) in group C (p = 0.15). Wound infections only occurred in groups C (n = 10, 12 %) compared to group PS (n = 0; 0 %; p = 0.034), and the wound closure technique was the only significant factor associated with surgical site infection. Surgery performed by a resident under supervision was not a risk factor for complications compared to the procedure done by a senior surgeon (p = 0.73).
This study reveals an advantage of the purse-string skin closure technique in ileostomy reversals analysing a large cohort of patients. Therefore, we recommend the use of the purse-string skin closure in ileostomy reversals as one way to lower wound infection rates.
伤口感染不仅会影响个体患者，还会导致医疗成本增加。回肠造口术逆转后，手术部位感染是一个常见问题。本研究的目的是在大量病例中比较荷包缝合法与传统皮肤缝合技术的感染率。
对2009年1月至2012年8月在歌德大学医院接受回肠造口术逆转的患者进行回顾性分析，评估手术部位感染及相关危险因素。患者接受传统皮肤缝合（连续缝合、间断缝合或吻合器缝合；C组）或皮下荷包缝合（PS组）。
共分析了114例患者。81例患者采用传统伤口缝合，33例患者接受荷包皮肤缝合。两组在年龄、性别、回肠造口术指征、既往化疗情况和手术时间方面无差异。PS组中位住院时间为7天（3 - 34天），C组为8天（3 - 53天）（p = 0.15）。与PS组（n = 0；0%）相比，伤口感染仅发生在C组（n = 10；12%）（p = 0.034），且伤口缝合技术是与手术部位感染相关的唯一显著因素。与由资深外科医生进行的手术相比，住院医生在监督下进行的手术不是并发症的危险因素（p = 0.73）。
本研究通过分析大量患者队列，揭示了荷包皮肤缝合技术在回肠造口术逆转中的优势。因此，我们建议在回肠造口术逆转中使用荷包皮肤缝合作为降低伤口感染率的一种方法。
