Gunsight Procedure Versus the Purse-String Procedure for Closing Wounds After Stoma Reversal: A Multicenter Prospective Randomized Trial

BACKGROUND Stoma reversal is associated with a high risk of wound infection. The gunsight and purse-string closure techniques are both effective alternatives for stoma reversal, but comparative studies are lacking. OBJECTIVE The purpose of this study was to compare the gunsight procedure with the purse-string closure technique when closing wounds after loop stoma reversal. DESIGN This was a nonblinded, multicenter prospective randomized study (clinicaltrials.gov No. NCT02053948). SETTINGS The study was conducted at a general surgery unit of 7 tertiary academic medical centers. PATIENTS A total of 143 patients undergoing loop stoma reversal were included in the study (72 in the gunsight group and 71 in the purse-string group) between November 2013 and December 2017. INTERVENTION Patients were randomly assigned to undergo either gunsight or purse-string closure procedure. MAIN OUTCOME MEASURES Primary outcome was wound healing time. Secondary outcomes were the incidence of surgical site infection, morbidity, and patient satisfaction. RESULTS No differences were found between the 2 groups in terms of surgical site infection, intraoperative blood loss, and postoperative hospital stay. The gunsight procedure had a shorter wound healing time compared with the purse-string procedure (17 vs 25 d; p < 0.001). A patient satisfaction questionnaire showed that the gunsight group had a higher score level of patient satisfaction with respect to wound healing time (p < 0.001) and total patient satisfaction score (p = 0.01) than the purse-string group. LIMITATIONS Treatment teams were not blinded, and there was operator dependence of techniques. CONCLUSIONS The gunsight and purse-string techniques are effective procedures for stoma reversal and both have a low incidence of surgical site infection. The gunsight technique is associated with shorter wound healing time, higher levels of patient satisfaction with regard to healing time, and overall final score and is recommended as the closure technique of choice. See Video Abstract at http://links.lww.com/DCR/B319. EL PROCEDIMIENTO DE GUNSIGHT VERSUS EL PROCEDIMIENTO DE JARETA, PARA EL CIERRE DE HERIDAS, DESPUeS DE REVERSIoN DE ESTOMA: UN ENSAYO, MULTICeNTRICO, PROSPECTIVO Y RANDOMIZADO: La reversion de estoma esta asociada con un alto riesgo de infeccion de la herida. Las tecnicas de gunsight y de jareta, son eficaces alternativas en la reversion de estoma, pero faltan estudios comparativos.Comparar el procedimiento de gunsight con la tecnica de jareta, despues de la reversion de estoma en asa.Estudio multicentrico, prospectivo y randomizado ciego (NCT02053948).Realizado en la unidad de cirugia general, de siete centros medicos academicos terciarios.Se incluyeron en el estudio, un total de 143 pacientes sometidos a reversion de estoma de asa (72 en el grupo de gunsight y 71 en el grupo de jareta) entre noviembre de 2013 y diciembre de 2017.Los pacientes fueron asignados aleatoriamente, para someterse a un procedimiento de cierre de gunsight o de jareta.El resultado primario fue el tiempo de cicatrizacion de la herida. Los resultados secundarios fueron la incidencia de infeccion del sitio quirurgico, morbilidad y satisfaccion del paciente.No se encontraron diferencias entre los dos grupos en terminos de infeccion del sitio quirurgico, perdida de sangre intraoperatoria o estadia hospitalaria postoperatoria. El procedimiento de gunsight tuvo un tiempo mas corto en la cicatrizacion de la herida, en comparacion con el procedimiento de jareta (17 dias frente a 25 dias, p