Comparison of Running Versus Interrupted Sutures for Fascial Closure in Ileostomy Takedown.

Abstract

Temporary loop ileostomies are common after colorectal cancer surgery to reduce anastomotic leak severity. However, ileostomy takedown carries risks like surgical site infections (SSIs) and incisional hernias. The optimal fascial closure technique during takedown remains debated. This study compared these techniques regarding postoperative complications. This retrospective study analyzed data from 69 patients undergoing scheduled loop ileostomy closure between 2016-2020 at two Romanian surgical departments. Data collected included demographics, clinical variables (ASA score, comorbidities), surgical details (suture type, closure time, skin closure type), and follow-up data including CT assessments for hernia detection. The cohort included 69 patients (mean age 63, 64% male). Fascial closure was used in 17 (24.7%) and interrupted in 52 (75.4%) patients. Running sutures were significantly faster (mean 19 vs. 22 min, p=0.028). Overall SSI rate was 21.7%. Ileostomy site incisional hernias occurred in 13 patients (18.6%) after a mean follow-up of 30.7 months. No statistically significant difference in hernia rates was found between running (3/17) and interrupted (10/52) suture groups (p=1). Significant risk factors for hernia development included longer follow-up (OR=0.87, p=.025), BMI≥30 (OR=176, p=.009), and Clavien-Dindo grade 3 postoperative complications (OR=112, p=.033). While running sutures offer faster fascial closure, this study found no significant difference in ileostomy site incisional hernia rates between running and interrupted techniques. Patient factors like BMI ≥30 and severe postoperative complications are significant predictors of hernia formation. Careful technique is crucial, but primary closure without mesh remains standard.