Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. The Cochrane Colorectal Group produces reviews across a wide range of conditions affecting the intestines. These were added to in March 2024 with a new review of different ways to close the skin when a person's stoma is reversed. We asked lead author, Shahab Hajibandeh from Health Education and Improvement Wales to tell us more and he used the ElevenLabs AI Voice Generator to record this podcast.

Shahab: An intestinal stoma is a surgically created opening into a person's intestines from the surface of the abdomen. It's used to divert intestinal content in both emergency and elective abdominal surgery settings and can be temporary or permanent, depending on the reason it's needed. Temporary stomas can be reversed in many patients, but the process is associated with up to 40% risk of wound infection, mainly due to the presence of bacteria around the stoma site.
The skin of the stoma site wound is conventionally closed in a straight line using the linear skin closure technique, but this is associated with a relatively high risk of wound infection. An alternative is to use a purse-string skin closure technique, in which a continuous stitch is placed in a circle around the stoma site wound, similar to the way that a thread closes a purse-string bag. This creates a small opening in the centre of the wound, resulting in free drainage of contaminants which might decrease the risk of wound infection.
We did our Cochrane Reviews to compare the effects of these two types of stitching and, based on the nine randomised trials that involved 757 people undergoing reversal of stoma, we're moderately confident that the purse-string skin closure technique is associated with a lower risk of wound infection. It might also lead to better patient satisfaction compared with the linear skin closure technique, but higher quality studies are needed to confirm this. Both techniques were similar for a variety of other outcomes, including the time needed to perform the operation and the incidence of incisional hernia in which tissue protrudes through the surgical scar.
In conclusion, therefore, the available evidence indicates that the purse-string skin closure technique is likely to be superior to the linear skin closure technique in reducing the risk of wound infection in patients undergoing reversal of stoma.

Mike: If you would like to learn more about these techniques for reversing a person's stoma, the full review is available online. If you go to Cochrane library dot com and search "stoma reversal" you'll see a link to it.