Comparison of Primary Versus Secondary Closure of Ileostomy

Munir Ahmad, Shahid Alam, Zahoor Ahmad, Mehmood Akhtar, Mussarat Hussain, Muhammad Uzair, Muzafar Uddin Sadiq


Background: Morbidity after stoma closure, however, is not negligible and the most common complication is postoperative surgical site infection. There is no consensus on the ideal closure technique of the stoma wound to minimize postoperative wound infection and multiple techniques have been proposed. The aim of this study was to compare the efficacy of primary versus secondary closure of ileostomy reversal skin wound in terms of wound infection. Material and Methods: This randomized controlled trial included 60 patients, which were divided into two groups, primary closure (A) in which wound was primarily closed at the end of procedure and secondary closure (B) in which wound was left open for secondary healing, after fullfilling the inclusive and exclusive criteria from november 2011 to october 2012. Wound infection was noted postoperatively and was recorded in a proforma. Data was analyzed using SPSS16. Results: There were 30 patients in each group.The male to female ratio and mean age ±S.D in group A and B were ( 3.3 : 1 and 2.75 : 1, P= .754 ) and ( 40.13 ± 1.32 and 41.6 ± 1.44, P= .902) )respectively. The incidence of wound infection in primary skin wound closure was in 7 ( 11.7% ) patients and 6 ( 10% ) patients in secondary wound closure ( P= .754 ) following ileostomy closure. There was no statistically significant effect of age and sex on the efficacy of primary versus secondary closure of ileostomy reversal skin wound, with the p- value of .807 and .587 respectively. The length of hospital stay was similar for both groups.
Conclusion: Primary closure should be encouraged as a routine method of closure of ileostomy-reversal skin wound.


Ileostomy reversal; Wound closure; Wound infection

Full Text:



Haq AU, Ahmad A. A study of complications related with colostomy closure. Ann KE Med Coll 2006;12:261-6.

Pokorny H, Herkner H, Jakesz R, Herbst F. Mortality and complications after stoma closure. Arch Surg 2005;140:956-60.

Anadol A, Topgül, Koray, Santulli. Enterostomy revisited: indications in adults. World J Surg 2006;30:1935-8.

Harris DA, Egbeare D, Jones S, Benjamin H, Woodward A, and Foster ME. Complications and mortality following stoma formation. Ann R Coll Surg Engl 2005; 87: 427–31.

Lahat G, Tulchinsky H, Goldman G, et al. Wound infection after ileostomy closure: a prospective randomized study comparing primary vs. delayed primary closure techniques. Tech Coloproctol 2005; 9:206-8.

Rajput A, Samad A, Khanzada TW. Temporary loop ileostomy: prospective study of indications and complications. Rawal Med J 2007;32:159-62.

Iqbal P, Saddique M, Baloch TA. Closure of ileostomy: a study of 74 cases. Pak J Surg 2008;24:98-101.

Kaiser AM, Israelit S, Klaristenfeld D, Selvindoss P, Vukasin P, Ault G, et al. Morbidity of ostomy takedown. J Gastrointest Surg 2008;12:437-41.

Siddiqui K, Ali Khan AF. Comparison of frequency of wound infection: Open Vs laparoscopic cholecystectomy. J Ayub Med Coll Abbottabad 2006;18:21-4.

Parker MC, Wilson MS, Menzies D, Sunderland G, Clark DN, Knight AD, et al. Surgical and clinical adhesions research (SCAR) Group. "The SCAR-3 study: 5-year adhesion-related readmission risk following lower abdominal surgical procedures". Colorectal Dis 2005;7:551–8.

Khan SA, Rodrigues G, Kumar P, Rao PGM. Current challenges in adherence to clinical guidelines for antibiotic prophylaxis in surgery. J Coll Physicians Surg Pak 2006;16:435-7.

Renzulli P, Candinas D. Intestinal stomas-indications, stoma types, surgical technique. Ther Umsch 2007;64:517-27.

N. Vermulst J, Vermeulen EJ, Hazebrock PP, Locoene E, Vanderhast. Primary closure of skin after stoma closure. Management of wound infections is easy without (long term) complications. The Notherland Dig Surg 2006;23:255-8.

W Baraza J, World W, Barbar S, Brown. Postoperative management after loop ileostomy closure: are we keeping patients in hospital too long. Ann R Coll Surg Eng 2010:92;51-5.

Ali SA, Soomro AG, Shaikh NA. Postoperative complications of loop ileostomy. JLUMHS 2009;8:23-5.

Bakx R, Busch OR, Bemelman WA, et al. Morbidity of temporary loop ileostomies. Dig Surg 2004;21:277-81.

Chow A, Tilney HS, Paraskeva P, et al. The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int J Colorectal Dis 2009;24:711-23.

Maddem GJ, Nejjari Y, Dennison A. Primary anastomosis with transverse colostomy as an alternative to Hartment procedure. Br J Surg 1995;82:170-1.

Mala T, Nesbakken A. Morbidity related to the use of a protective stoma in anterior resection for rectal cancer. Colorectal Dis 2008;10:785-8.

Feinberg S, Mc Leod R, Cohen A. Complications of loop ileostomy. Am J Surg 1987;153:102-7.

Van de Pavoordt H, Fazio V, Jagelman D, et al. The outcome of loop ileostomy closure in 293 cases. Int J Colorect Dis 1987;2:214-7.

Khoo R, Cohen M, Chapman G, et al. Loop ileostomy for temporary fecal diversion. Am J Surg 1994;167:519-22.

Phang P, Hain J, Pere-Ramirez J, et al. Techniques and complications of ileostomy takedown. Am J Surg 1999;177:463-6.

Amin S, Memon M, Ar+mitage N, et al. Defunctioning loop ileostomy and staples side-to-side closure has low morbidity. Ann R Coll Surg Engl 2001;83:246-9.

Wong K, Remzi F, Gorgun E, et al. Loop ileostomy closure after restorative proctocolectomy: outcome in 1,504 patients. Dis Colon Rectum 2005;48:243-50.

Hackam D, Rotstein O. Stoma closure and wound infection: an evaluation of risk factors. Can J Surg 1995;38:144-8.

Lee JR, Kim YW, et al. Conventional linear versus purse-string skin closure after loop ileostomy reversal: Comparison of wound infection rates and operative outcomes. J Korean Soc Coloproctol 2011:27;58-63.

Marquez TT, Christoforidis D, Abraham A, Mandoff RD, Rothenberger DA. Wound infection following stoma takedown: Primary skin closure versus subcuticular purse-string suture. World J Surg 2010;34:2877-82.


  • There are currently no refbacks.

Copyright (c) 2020 Munir Ahmad, Shahid Alam, Zahoor Ahmad, Mehmood Akhtar, Mussarat Hussain, Muhammad Uzair, Muzafar Uddin Sadiq

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.