Randomized Controlled Trial
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2024; 16(1): 186-195
Published online Jan 27, 2024. doi: 10.4240/wjgs.v16.i1.186
Micro-power negative pressure wound technique reduces risk of incision infection following loop ileostomy closure
Deng-Yong Xu, Bing-Jun Bai, Lina Shan, Hui-Yan Wei, Deng-Feng Lin, Ya Wang, Da Wang
Deng-Yong Xu, Bing-Jun Bai, Lina Shan, Deng-Feng Lin, Da Wang, Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Hui-Yan Wei, Department of Wound & Ostomy Care Clinic, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Ya Wang, Department of Hospital Infection Control, Zhejiang Cancer Hospital, Hangzhou 310005, Zhejiang Province, China
Author contributions: Xu DY and Bai BJ were responsible for the study conception and design; Shan LN and Wei HY analyzed the data and wrote the manuscript; Lin DF, Wang Y, and Wang D critically revised the article for important intellectual content; all the authors reviewed and approved the final version to be published.
Supported by the Zhejiang Provincial Natural Science Foundation of China, No. LQ20H260002.
Institutional review board statement: The study was reviewed and approval by the Ethics Committee of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University (No. 20191217-9).
Clinical trial registration statement: The trial was registered at Chinese Clinical Trial Registry at https://www.chictr.org.cn (registration number: ChiCTR2200064827).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All authors declare no potential conflicting interests related to this paper.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
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: Da Wang, MD, Professor, Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3 East Qingchun Road, Hangzhou 310016, Zhejiang Province, China. 3204004@zju.edu.cn
Received: August 22, 2023
Peer-review started: August 22, 2023
First decision: November 20, 2023
Revised: November 30, 2023
Accepted: December 13, 2023
Article in press: December 13, 2023
Published online: January 27, 2024
Processing time: 156 Days and 1.8 Hours
Abstract
BACKGROUND

Prophylactic loop ileostomy is an effective way to reduce the clinical severity of anastomotic leakage following radical resection of rectal cancer. Incisional surgical site infection (SSI) is a common complication after ileostomy closure.

AIM

To evaluate the efficacy and safety of the micro-power negative pressure wound technique (MPNPWT) in preventing incisional SSI.

METHODS

This was a prospective, randomized controlled clinical trial conducted at a single center. A total of 101 consecutive patients who underwent ileostomy closure after rectal cancer surgery with a prophylactic ileostomy were enrolled from January 2019 to December 2021. Patients were randomly allocated into an MPNPWT group and a control group. The MPNPWT group underwent intermittent suturing of the surgical incision with 2-0 Prolene and was covered with a micro-power negative pressure dressing. The surgical outcomes were compared between the MPNPWT (n = 50) and control (n = 51) groups. Risk factors for incisional SSI were identified using logistic regression.

RESULTS

There were no differences in baseline characteristics between the MPNPWT (n = 50) and control groups (n = 51). The incisional SSI rate was significantly higher in the control group than in the MPNPWT group (15.7% vs 2.0%, P = 0.031). However, MPNPWT did not affect other surgical outcomes, including intra-abdominal complications, operative time, and blood loss. Postoperative hospital stay length and hospitalization costs did not differ significantly between the two groups (P = 0.069 and 0.843, respectively). None of the patients experienced adverse effects of MPNPWT, including skin allergy, dermatitis, and pain. MPNPWT also helped heal the infected incision. Our study indicated that MPNPWT was an independent protective factor [odds ratio (OR) = 0.005, P = 0.025)] and diabetes was a risk factor (OR = 26.575, P= 0.029) for incisional SSI.

CONCLUSION

MPNPWT is an effective and safe way to prevent incisional SSI after loop ileostomy closure.

Keywords: Micro-power negative pressure technique; Ileostomy closure; Incisional surgical site infection; Infection prevention; Postoperative incision

Core Tip: This is the first study to apply the micro-power negative pressure wound technique (MPNPWT) to postoperative incision for incisional surgical site infection (SSI) prevention. The efficacy and safety of MPNPWT in preventing incisional SSI after ileostomy closure were evaluated. Our study showed that MPNPWT significantly reduced the incisional SSI rate to a low level (2.0%). No patients suffered adverse effects with MPNPWT. MPNPWT is an effective and safe way to prevent incisional SSI after loop ileostomy closure.