Ostomy reversal closure

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anbuitachi

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What is the logic for leaving the ostomy site open and packing it after reversal? Why not just suture it closed?

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some people believe there is high rate of infection so they let it close by secondary intent
 
I suppose it doesn't help my stats and perhaps will one day make my reimbursement suffer, but I close the ostomy site loosely over a penrose and accept that some will still get infected. All the ones that don't (and even some of the ones that do if it is mild) appreciate not having to pack a big wound and have a bigger scar. I do use staples though so it is easy enough to pop them out.
 
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I suppose it doesn't help my stats and perhaps will one day make my reimbursement suffer, but I close the ostomy site loosely over a penrose and accept that some will still get infected. All the ones that don't (and even some of the ones that do if it is mild) appreciate not having to pack a big wound and have a bigger scar. I do use staples though so it is easy enough to pop them out.
I do something similar by closing the edges with staples and pack the very center with iodoform or gauze, depending on size. Usually heals up quickly unless the patient is obese. After changing stoma bags for a while, I find patients aren't too freaked out by packing a wound.

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My attendings range the gamut from closing it completely, closing over a drain, to laving it wide open.

My favorite approach that I plan on using moving forward is to pursestring the defect down with a couple of circumferential sutures in the deep tissue and subq. It gets pretty small and is still easy to pack. Heals up pretty quickly that way and the patients I've seen back in clinic it looks good.
Interesting
 
My favorite approach that I plan on using moving forward is to pursestring the defect down with a couple of circumferential sutures in the deep tissue and subq. It gets pretty small and is still easy to pack. Heals up pretty quickly that way and the patients I've seen back in clinic it looks good.

This is what a few of our attendings do as well. They actually just do one deep dermal purse string, then put a piece of rolled telfa in the defect. Telfa comes out after 2-3 days and they don't even continue packing. Site eventually heals down like a little pucker mark. My plan is to use this technique as well...seems to be the best combo of minimizing wound infection and making it easy for the patient.
 
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Pursestring closure has a large volume of data supporting it over routine closure. They rarely get infected, and in the long run, the cosmesis is very good (looks like a small circular scar). Still, it's a bit unnerving when you first start doing it because it looks silly initially with skin puckering, etc. I promise that it heals nicely, and I encourage you guys to try it. I use a 0 maxon.

Pursestring Closure versus Conventional Primary Closure Following Stoma Reversal to Reduce Surgical Site Infection Rate: A Meta-analysis of Randomi... - PubMed - NCBI
Randomized clinical trial of intestinal ostomy takedown comparing pursestring wound closure vs conventional closure to eliminate the risk of wound ... - PubMed - NCBI
Pursestring closure of the stoma site leads to fewer wound infections: results from a multicenter randomized controlled trial. - PubMed - NCBI
 
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My attendings range the gamut from closing it completely, closing over a drain, to laving it wide open.

My favorite approach that I plan on using moving forward is to pursestring the defect down with a couple of circumferential sutures in the deep tissue and subq. It gets pretty small and is still easy to pack. Heals up pretty quickly that way and the patients I've seen back in clinic it looks good.
we do exactly the same!
 
We use PDS. I've still only ever heard of and never seen this Maxon stuff.

Same thing, as you know. US Surgical/Covidien sutures but essentially the same stitch. Maxon=PDS, caprosyn=monocryl, polysorb=vicryl, Ticron=Ethibond, silk=silk, surgipro=prolene, chromic=chromic.

In general, I prefer the ethicon stuff, but it's been 5 years since I've had unrestricted access to them, so I've been forced to adjust.
 
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Same thing, as you know. US Surgical/Covidien sutures but essentially the same stitch. Maxon=PDS, caprosyn=monocryl, polysorb=vicryl, Ticron=Ethibond, silk=silk, surgipro=prolene, chromic=chromic.

In general, I prefer the ethicon stuff, but it's been 5 years since I've had unrestricted access to them, so I've been forced to adjust.
Equivalent I suppose, but actually a different polymer (unlike the others which are the same substance). I too have never seen Maxon.
 
Most my attendings delay primary closure it (place the nylon sutures, pack it for a few days, if it looks clean d3 ish will tie down the sutures bedside.
 
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