A combination of subcuticular sutures and subcutaneous closed-suction drainage reduces the risk of incisional surgical s
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ORIGINAL ARTICLE
A combination of subcuticular sutures and subcutaneous closed‑suction drainage reduces the risk of incisional surgical site infection in loop ileostomy closure Kohei Fukuoka1 · Fumikazu Koyama1,2 · Hiroyuki Kuge1 · Shinsaku Obara1 · Takayuki Nakamoto1,2 · Yosuke Iwasa1 · Takeshi Takei1 · Yayoi Matsumoto1 · Tomomi Sadamitsu1 · Masayuki Sho1 Received: 20 May 2020 / Accepted: 13 August 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose The purpose of this study was to evaluate the effectiveness of a wound closure method using a combination of subcuticular sutures and subcutaneous closed-suction drainage (SS closure) for preventing incisional surgical site infection (SSI) in loop ileostomy closure. Methods A total of 178 consecutive patients who underwent loop ileostomy closure at Nara Medical University Hospital between 2004 and 2018 were retrospectively assessed. The patients were divided into 2 groups: the conventional skin closure (CC) group from 2004 to 2009 (75 patients) and the SS closure (SS) group from 2010 to 2018 (103 patients). The incidence of incisional SSI was compared between the two groups, and the factors associated with incisional SSI were examined by univariate and multivariate analyses. Results Incisional SSI occurred in 7 cases (9.3%) in the CC group but was significantly reduced to only 1 case (0.9%) in the SS group (p = 0.034). In the univariate analysis, the hemoglobin levels, serum creatinine levels, and SS closure were associated with incisional SSI. SS closure was the only independent preventive factor for incisional SSI according to the multivariate analysis (hazard ratio = 0.24, p = 0.011). Conclusion The combination of subcuticular sutures and subcutaneous closed-suction drainage may be a promising way of preventing incisional SSI in loop ileostomy closure. Keywords Loop ileostomy closure · Subcuticular suture · Closed-suction drainage · Surgical site infection
Introduction Diverting loop ileostomy is commonly performed to protect a downstream anastomotic site in colorectal surgery, such as anal-preserving operation for rectal cancer and inflammatory bowel disease (IBD) [1, 2]. Closure of loop ileostomy is a minor operation, but the complication rate is high, Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00595-020-02128-x) contains supplementary material, which is available to authorized users. * Fumikazu Koyama fkoyama@naramed‑u.ac.jp 1
Department of Surgery, Nara Medical University, 840 Shijo‑cho, Kashihara, Nara 634‑8522, Japan
Division of Endoscopy, Nara Medical University Hospital, 840 Shijo‑cho, Kashihara 634‑8522, Nara, Japan
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with complications reported in up to 41% of cases [3–5]. Incisional surgical site infection (SSI) is one of the most common complications after ileostomy closure, with an incidence rate of 3.1–40% [6–8]. Although incisional SSI is not a lethal complication, it increases medical costs, prolongs hospital stay, and reduces the patient quality of life (QOL) [9].
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