Abstract
BackgroundThe aim of this study was to assess the usefulness of protective negative-pressure wound therapy (NPWT) in the reduction of wound healing complications (WHC) and surgical site infections (SSI) after diverting ileostomy closure in patients who underwent surgery for colorectal cancer.MethodsIn this prospective randomized clinical trial in a tertiary academic surgical center, patients who had colorectal cancer surgery with protective loop ileostomy and were scheduled to undergo ileostomy closure with primary wound closure from January 2016 to December 2018 were randomized to be treated with or without NPWT. The primary endpoint was the incidence of WHC. Secondary endpoints were incidence of SSI, length of postoperative hospital stay (LOS), and length of complete wound healing (CWH) time.ResultsWe enrolled 35 patients NPWT (24 males [68.6%]; mean age 61.6 ± 11.3 years), with NPWT and 36 patients (20 males [55.6%]; mean age 62.4 ± 11.3 years) with only primary wound closure (control group). WHC was observed in 11 patients (30.6%) in the control group and 3 (8.57%) in the NPWT group (p = 0.020). Patients in the NPWT group had a significantly lower incidence of SSI (2 [5.71%] vs. 8 [22.2%] in the control group; p = 0.046) as well as significantly shorter median CWH (7 [7–7] days vs. 7 [7–15.5] days, p = 0.030). There was no difference in median LOS between groups (3 [2.5–5] days in the control group vs. 4 [2–4] days in the NPWT group; p = 0.072).ConclusionsProphylactic postoperative NPWT after diverting ileostomy closure in colorectal cancer patients reduces the incidence of WRC and SSI.Clinical trial registrationclinicaltrials.gov (NCT04088162).
Highlights
Surgeries for colorectal cancer, especially procedures involving the lower rectum, are associated with a very high percentage of complications [1,2,3]
In the two study groups, patients were treated with postoperative negative-pressure wound therapy (NPWT) (24 males [68.6%]; mean age 61.6 ± 11.3 years), and patients (20 males[55.6%]; mean age 62.4 ± 11.3 years) were treated with suturing of the wound and traditional dressings
wound healing complications (WHC) were observed in 3 (8.6%) patients in the NPWT group and 11 (30.6%) in the control group (p = 0.020)
Summary
Surgeries for colorectal cancer, especially procedures involving the lower rectum, are associated with a very high percentage of complications [1,2,3]. One way to reduce the risk of leak is to use a diverting ileostomy [6, 7] This is currently considered a standard treatment, especially in the group of patients undergoing neoadjuvant radiotherapy or chemoradiotherapy, the technique still has its drawbacks, such as the necessity to perform an additional surgical operation for ileostomy closure, which has a high risk of wound healing complications, surgical site infections (SSI) [8, 9]. The aim of this study was to assess the usefulness of protective negative-pressure wound therapy (NPWT) in the reduction of wound healing complications (WHC) and surgical site infections (SSI) after diverting ileostomy closure in patients who underwent surgery for colorectal cancer.
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