F Menegon Tasselli, F Pata, G Fuschillo, G Signoriello, A Bondurri, G Sciaudone, F Selvaggi, G Pellino
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The primary outcome was 30-day SSI; secondary outcomes were operative time, length of stay, and incisional hernia.</p><p><strong>Results: </strong>Eight RCTs were identified that included a total of 606 patients undergoing stoma closure surgery. Four percent of patients in the CSC group developed SSI, compared to 27% of patients undergoing PS. The 30-day SSI rate was lower after the circular skin closure (OR 0.11, 95% CI 0.06-0.21; p < 0.00001, I<sup>2</sup> = 0%). 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引用次数: 0
摘要
背景：手术部位感染（SSI）是造口术后最常见的并发症。圆形皮肤闭合（CSC）已被提出用于减少SSI，其效果与传统的初级缝合（PS）相当甚至更好。本荟萃分析的目的是比较圆形皮肤闭合和初级皮肤闭合在造口闭合中的效果。方法：系统回顾2010年1月至2023年6月发表的文献，包括所有成年患者造口逆转后伤口感染的随机对照试验（RCT）。主要结局为30天SSI；次要结果为手术时间、住院时间和切口疝。结果：8项随机对照试验共纳入606例接受造口手术的患者。CSC组中有4%的患者发生SSI，而PS组中有27%的患者发生SSI。环状皮肤闭合后30天的SSI发生率较低(OR 0.11, 95% CI 0.06-0.21；p 2 = 0%)。两组手术时间差异无统计学意义(99.2 vs 103.5 min；Md - 0.17, 95% ci - 0.37, 0.03；P = 0.10)、停留时间(7.1 vs 7.7天；Md - 0.34, 95% ci - 0.55, - 0.12；P = 0.002)，切口疝率(2% vs 4%；或0.61,95% ci 0.23, 1.60；p = 0.31)。结论：CSC与较低的SSI发生率相关，在造口手术后应优先采用线性皮肤闭合技术。
Circular (purse-string) vs primary skin closure following stoma closure: an up-to-date systematic review and meta-analysis.
Background: Surgical site infections (SSI) are the most common complication after stoma closure. Circular skin closure (CSC) has been proposed to reduce SSI with comparable or even better outcomes than conventional primary sutures (PS). The aim of this meta-analysis is to compare circular with primary skin closure in stoma closure.
Method: A systematic review of the literature was performed for articles published between January 2010 and June 2023, including all randomized control trials (RCT) on wound infection of adult patients following stoma reversal. The primary outcome was 30-day SSI; secondary outcomes were operative time, length of stay, and incisional hernia.
Results: Eight RCTs were identified that included a total of 606 patients undergoing stoma closure surgery. Four percent of patients in the CSC group developed SSI, compared to 27% of patients undergoing PS. The 30-day SSI rate was lower after the circular skin closure (OR 0.11, 95% CI 0.06-0.21; p < 0.00001, I2 = 0%). There was no difference in the operative time (99.2 vs 103.5 min; MD - 0.17, 95% CI - 0.37, 0.03; p = 0.10), length of stay (7.1 vs 7.7 days; MD - 0.34, 95% CI - 0.55, - 0.12; p = 0.002), and incisional hernia rate (2% vs 4%; OR 0.61, 95% CI 0.23, 1.60; p = 0.31).
Conclusion: CSC is associated with lower SSI rate and should be preferred to linear skin closure technique after stoma closure surgery.
期刊介绍：
Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.
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