Philippine Journal of Surgical Specialties Vol. 67, No. 2, April-June 2012, pp 53-60

A Randomized Controlled Clinical Trial Comparing the Outcomes of Circumferential Subcuticular Wound Approximation (CSWA) with Conventional Wound Closure After Stoma Reversal: An Interim Report

Author(s): Mark Francis A. Melendres, M.D.; Marc Paul J. Lopez, M.D.; Manuel Francisco T. Roxas, M.D., F.P.C.S.; Hermogenes J. Monroy III, M.D., F.P.C.S. and Armando C. Crisostomo, M.D., F.P.C.S.

The creation of a stoma is commonplace in colorectal surgery. Circumferential subcuticular wound approximation (CSWA) is a method of wound closure following stoma reversal proposed by Milanchi, et al. It has been reported to result in decreased wound infection rates and more desirable aesthetic outcomes. The authors aimed to determine the effectiveness of the CSWA method, in terms decreasing wound infection, and cosmesis by comparing the technique with the conventional method of wound closure.

All adult patients who presented for stoma reversal at the outpatient clinic of the Division of Colorectal Surgery at the University of the Philippines-Philippine General Hospital (UP-PGH) were randomized into two groups, CSWA and conventional, and their stomas cloud accordingly. Patients were followed up for one month, with photographic documentation of wound appearance and estimation of wound infections and complications. Patients were asked to complete a satisfaction survey at the end of the follow-up period.

Sixty-two patients have been recruited since the start of the study, representing more than one-third of the computed sample size. Fifty-six patients were able to complete the one-month follow-up. No wound infection was documented for the CSWA arm, while 3 (11.11%) patients had a wound infection in the conventional arm (P=0.1055). Patients in the CSWA group had a higher overall satisfaction score (25.3 vs 23.6), but this did not carry statistical significance (P = 0.0749).

Performing the CSWA method resulted in a lower wound infection rate as compared to the conventional method of wound closure after stoma reversal. Patients who underwent CSWA were found to be more satisfied with the appearance of their wound. These initial results show that the CSWA method remains a viable option in wound closure after stoma reversal.
Conclusions: The level of awareness about the PCS Thyroid Guidelines needs to be improved. The dissemination process needs to be reviewed and ensure that all stakeholders will be reached.

Key words: wound infection, ileostomy closure, colostomy closure, circumferential subcuticular wound approximation