Systematic review and meta-analysis of published randomized controlled trials comparing purse-string vs conventional linear closure of the wound following ileostomy(stoma)closure

Objective:The objective of this article is to systematically analyse the randomized,controlled trials comparing the effectiveness of purse-string closure(PSC)of an ileostomy wound with conventional linear closure(CLC).Methods:Randomized,controlled trials comparing the effectiveness of purse-string closure vs conventional linear closure(CLC)of ileostomy wound in patients undergoing ileostomy closure were analysed using RevMan-,and the combined outcomes were expressed as risk ratio(RR)and standardized mean difference(SMD).Results:Three randomized,controlled trials,recruiting 206 patients,were retrieved from medical electronic databases.There were 105 patients in the PSC group and 101 patients in the CLC group.There was no heterogeneity among included trials.Duration of operation(SMD:-0.18;95%CI:-0.45,0.09;z=1.28;P<0.20)and length of hospital stay(SMD:0.01;95%CI:-0.26,0.28;z=0.07;P<0.95)was statistically similar following both approaches of ileostomy wound closure.The risk of surgical site infection(OR,0.10;95%CI:0.03,0.33;z=3.78;P<0.0001)was significantly reduced when ileostomy wound was closed using PSC technique.Conclusion:PSC technique for ileostomy wound is associated with a reduced risk of surgical site infection apparently without influencing the duration of operation and length of hospital stay.

Repair of left ventricular aneurysm during off-pump coronary artery bypass surgery

Background Acute myocardial infarction can result in left ventricularaneurysm, which may in turn cause congestive heart failure, ventricular arrhythmia andthromboembolic events. This study evaluates results achieved with a modified linear closure of leftventricular aneurysms during off-pump coronary artery bypass surgery. Methods From January 2001 toMay 2004, 75 patients were operated on for nonruptured, postinfarctional, left ventricular aneurysmduring off-pump coronary artery bypass surgery. Repair was completed on the beating heart tominimize ischaemia and allow assessment of wall function and viability to guide closure. Allpatients presented with symptoms of angina and congestive heart failure or ventricular arrhythmia.The majority (75% ) of the patients were in NYHA functional class Ⅲ or Ⅳ. Preoperative ejectionfraction was 26% ±9%. The mean left ventricular, end diastolic diameter was (57. 5 ±7. 1) mm. Theventricular preoperative and postoperative performances were compared. χ~2 test and Student' s ttest were used to analyse the outcomes. A P value less than 0. 05 was considered significant.Results Hospital mortality was 1. 3% (1/75). Coronary artery bypass was performed with an average of(3. 3 ±1.2) grafts per patient. At the time of followup, all the patients had no symptoms. Themean NYHA class and ejection fraction increased significantly (P < 0.001 ) . The mean leftventricular, end diastolic diameter decreased significantly (P <0. 001). Conclusions Surgicalclosure of left ventricular aneurysm can be performed during off-pump coronary artery bypass. Theoperation is associated with a low inhospital mortality and morbidity. A postoperative improvementin the early term cardiac functions and symptoms and quality of life was documented, increasing ourexpectations of an increased long-term survival.