Adv Pediatr Surg.  2023 Jun;29(1):9-16. 10.13029/aps.2023.29.1.9.

Purse-String Closure for Stoma Reversal in Pediatric Patients

• Koo Ej
• Jung E

• KMID: 2551507
• DOI: http://doi.org/10.13029/aps.2023.29.1.9

Abstract

Purpose
Temporary stoma formation is a common procedure in pediatric surgery. Surgical site infection after stoma reversal surgery is a common complication, and the cosmetic effect after skin suturing is reduced. Purse-string closure has been suggested for stoma reversal, preventing surgical site infections and providing better cosmesis. Positive results have been reported abroad for the purse-string closure technique for stoma reversal in pediatric patients; however, no cases have been reported in Korea. Therefore, we aimed to investigate the outcomes of purse-string closure for stoma reversal in pediatric patients.
Methods
From October 2018 to September 2022, all pediatric patients who underwent stoma reversal at the Department of Pediatric Surgery were included. The electronic medical records of the patients were retrospectively reviewed. The following variables were analyzed: perinatal data including gestational age, sex, birth weight, Apgar score, and types of delivery; preoperative conditions including total parental nutrition, steroid use, and tracheal intubation; operational data such as diagnosis, types of stoma, age, body weight, skin closure methods and operation time; and postoperative data such as surgical site infection, transfusion, days until extubation, and start of enteral feeding. The serial wound healing process after purse-string closure was documented using photographs.
Results
Thirty-seven patients underwent stoma reversal surgery, 14 underwent purse-string closure, and 23 underwent conventional lineal closure. No surgical site infection occurred in the purse-string group and four cases of surgical site infection occurred in the conventional liner group. However, there were no statistically significant differences between both groups (p=0.276).
Conclusion
No surgical wound infection was found in pediatric patients who underwent purse-string closure for stoma reversal, and the cosmetic effect was promising. However, no statistically significant difference was found between the purse-string closure and conventional linear closure groups. Further multicenter studies involving a larger sample size are needed to determine statistical significance.

Keyword

Ileostomy; Colostomy; Surgical site infections; Pediatric