Association between incisional surgical site infection and the type of skin closure after stoma closure.

Kobayashi, Shin; Ito, Masaaki; Sugito, Masanori; Kobayashi, Akihiro; Nishizawa, Yusuke; Saito, Norio

PURPOSE This study was performed to investigate the effect of subcuticular sutures on the incidence of incisional surgical site infection (SSI) after closure of a diverting stoma. METHODS The study was carried out as a retrospective analysis of prospectively collected data from 51 patients who underwent closure of diverting stoma following resections of lower rectal cancer between January 2008 and December 2008. This study attempted to determine whether there was an association between the type of skin closure and the incidence of incisional SSI. Moreover, risk factors for incisional SSI after closure of diverting stoma were identified using a multivariate analysis. RESULTS An incisional SSI occurred in 12 of the 51 patients (23.5%). The rate of incisional SSI with subcuticular sutures was 11.1% (3/27) in comparison to 37.5% (9/24) with transdermal suture and skin stapler. A subcuticular skin closure was the only favorable factor that was significantly associated with a lower incidence of incisional SSI (odds ratio: 0.19; 95% confidence interval: 0.04-0.92). CONCLUSIONS A subcuticular skin closure has a protective effect against incisional SSI after closure of diverting stoma. A larger study is necessary to further define the role of subcuticular suture on the prevention of incisional SSI in cases of gastrointestinal surgery.