Case Control Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2023; 29(29): 4571-4579
Published online Aug 7, 2023. doi: 10.3748/wjg.v29.i29.4571
Comparison of modified gunsight suture technique and traditional interrupted suture in enterostomy closure
Chang Chen, Xiang Zhang, Zhi-Qiang Cheng, Bin-Bin Zhang, Xin Li, Ke-Xin Wang, Yong Dai, Yan-Lei Wang
Chang Chen, Xiang Zhang, Zhi-Qiang Cheng, Ke-Xin Wang, Yong Dai, Yan-Lei Wang, Department of Colorectal Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
Bin-Bin Zhang, Department of Nursing, Qilu Hospital of Shandong University De Zhou Hospital, Dezhou 254300, Shandong Province, China
Xin Li, Department of General Surgery, Huantai Branch of Qilu Hospital of Shandong University, Zibo 255000, Shandong Province, China
Author contributions: Chen C and Zhang X contributed equally to this work; Wang YL, Zhang X, Cheng ZQ, Zhang BB, Wang KX, and Dai Y designed the study; Chen C and Li X carried out relevant clinical work and data collection; Chen C and Zhang X analyzed the data and wrote the manuscript; and all authors have read and approved the final manuscript.
Supported by the Natural Science Foundation of Shandong Province, No. ZR2020MH257.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Qilu Hospital (Approval No. KYLL-2020-120).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: The dataset generated or analyzed in this study is not available to the public. Due to privacy and ethical considerations, we are unable to provide relevant data. We will ensure compliance with relevant regulations and policies to protect the privacy and confidentiality of participants. If you have specific questions or questions about this study, please feel free to contact the corresponding author at any time.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan-Lei Wang, MD, PhD, Adjunct Associate Professor, Deputy Director, Doctor, Department of Colorectal Surgery, Qilu Hospital, Shandong University, No. 107 Wenhua West Road, Lixia District, Jinan 250012, Shandong Province, China. yanleiwang@hotmail.com
Received: June 19, 2023
Peer-review started: June 19, 2023
First decision: July 6, 2023
Revised: July 10, 2023
Accepted: July 17, 2023
Article in press: July 17, 2023
Published online: August 7, 2023
Abstract
BACKGROUND

Prophylactic enterostomy surgery is a common surgical approach used to reduce the risk of anastomotic leakage in patients who have undergone partial intestinal resection due to trauma or tumors. However, the traditional interrupted suturing technique used in enterostomy closure surgery has several issues, including longer surgical incisions and higher incision tension, which can increase the risk of postoperative complications. To address these issues, scholars have proposed the use of a “gunsight suture” technique. This technique involves using a gunsight incision instead of a traditional linear incision, leaving a gap in the center for the drainage of blood and fluid to reduce the risk of infection. Building on this technique, we propose an improved gunsight suture technique. A drainage tube is placed at the lowest point of the incision and close the gap in the center of the gunsight suture, which theoretically facilitates early postoperative mobility and reduces the burden of dressing changes, thereby reducing the risk of postoperative complications.

AIM

To compare the effectiveness of improved gunsight suture technique with traditional interrupted suture in closing intestinal stomas.

METHODS

In this study, a retrospective, single-center case analysis was conducted on 270 patients who underwent prophylactic ileostomy closure surgery at the Department of Colorectal Surgery of Qilu Hospital from April 2017 to December 2021. The patients were divided into two groups: 135 patients received sutures using the improved gunsight method, while the remaining 135 patients were sutured with the traditional interrupted suture method. We collected data on a variety of parameters, such as operation time, postoperative pain score, body temperature, length of hospital stays, laboratory indicators, incidence of incisional complications, number of wound dressing changes, and hospitalization costs. Non-parametric tests and chi-square tests were utilized for data analysis.

RESULTS

There were no statistically significant differences in general patient information between the two groups, including the interval between the first surgery and the stoma closure [132 (105, 184) d vs 134 (109, 181) d, P = 0.63], gender ratio (0.64 vs 0.69, P = 0.44), age [62 (52, 68) years vs 60 (52, 68) years, P = 0.33], preoperative body mass index (BMI) [23.83 (21.60, 25.95) kg/m² vs 23.12 (20.94, 25.06) kg/m², P = 0.17]. The incidence of incision infection in the improved gunsight suture group tended to be lower than that in the traditional interrupted suture group [ (n = 2/135, 1.4%) vs (n = 10/135, 7.4%), P < 0.05], and the postoperative hospital stay in the improved gunsight suture group was significantly shorter than that in the traditional interrupted suture group [5 (4, 7) d vs 7 (6, 8) d, P < 0.05]. Additionally, the surgical cost in the modified gunsight suture group was slightly lower than that in the traditional suture group [4840 (4330, 5138) yuan vs 4980 (4726, 5221) yuan, P > 0.05], but there was no significant difference in the total hospitalization cost between the two groups.

CONCLUSION

In stoma closure surgery, the improved gunsight technique can reduce the incision infection rate, shorten the postoperative hospital stay, reduce wound tension, and provide better wound cosmetic effects compared to traditional interrupted suture.

Keywords: Enterostomy, Abdominal wound closure technique, Suture techniques, Surgical wound infection, Hospital costs, Hospital stay

Core Tip: Based on the gunsight technique, we proposed an improved gunsight closure method for enterostomy surgery in this study. This closure method can reduce the incision tension, lower the risk of incision infection, decrease the length of hospital stay, and reduce hospitalization costs. Additionally, it requires less postoperative wound care and provides a better cosmetic outcome.