Infectious Complications After Modified Purse-String Stoma Closure

Abstract

Purpose: Current society guidelines recommend purse-string closure technique for stoma reversal, which has been shown to reduce but not eliminate the risk of deep surgical site infection (SSI) at the original stoma site, a complication associated with increased morbidity and cost. We studied an adjunctive technique to further reduce the risk of SSI. Methods: A retrospective chart review was conducted on adult patients who underwent stoma reversal between May 2016 - July 2022. Stoma reversal was performed with purse-string closure, and placement of a strip of povidone-iodine soaked non-adherent pad in the remaining two cm opening at the prior stoma site. This pad was taken out on post-operative day one and changed to wet-to-dry saline moistened gauze. Results: 82 patients were identified. The cohort had a median BMI 26.5 [IQR 23.0-31.0] and median age 57.5 [IQR 45.8-67.0]. Mean time from original surgery to reversal was nine months. 59.8% identified as female, 24.4% were currently smoking, 18.3% were had diabetes. The cohort experienced a 11.0% readmission rate and 18.3% rate of stoma site hernia with a mean follow up of 17 17 months. No patient developed an SSI. Conclusion: In this cohort study with known risk factors for SSI, no patients undergoing stoma reversal experienced a post-operative SSI. The adjunctive technique of a povidone-iodine soaked non-adherent pad in addition to purse-string closure should be further examined in conjunction with surgical bundles to reduce the risk of SSI and overall morbidity of stoma reversal surgery.