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Background <p>Stoma creation is an essential part of general surgery, used in procedures such as protective loop ileostomy formed during low rectal resection or coloanal anastomosis, and in Hartmann’s procedures, often performed in emergency settings. Despite its clinical importance, the optimal wound closure technique following stoma reversal remains controversial. This study aims to identify a more effective wound closure method following stoma takedown.</p> Methods <p>Between June 1, 2017, and January 31, 2020, we prospectively observed 75 patients at the University of Debrecen, Hungary, who underwent stoma closure (29 colostomies and 46 ileostomies). Among these patients, 37 underwent purse-string “Volcano” suture closure (VSC), while 38 underwent primary suture closure (PSC). We recorded demographic data, operative times, and postoperative outcomes, including wound infections. The primary endpoint was the rate of surgical site infection (SSI) in the short-term and the occurrence of postoperative hernia in the long-term period. Secondary endpoints included operative time, duration of wound dressing, and surgical complications according to the Clavien–Dindo classification. The planned follow-up period for long-term complications was 5 years. In this study, Surgical Site Infection (SSI) was defined and classified strictly according to the Centers for Disease Control and Prevention (CDC) Guideline for the Prevention of Surgical Site Infection (2017).</p> Results <p>No significant differences were observed between the VSC and PSC groups in age, sex, BMI, comorbidities, ASA classification, time from primary surgery to stoma closure, or length of hospital stay. However, the operative time was significantly shorter in the VSC group (59&#xa0;min) compared to the PSC group (87&#xa0;min; <i>p</i> = 0.034). Notably, the incidence of postoperative wound infection was 0% in the VSC group and 18.4% in the PSC group respectively (<i>p</i> = 0.012).</p> Conclusion <p>Our prospective observational study demonstrates that the “Volcano” (purse-string) wound closure technique provides significant advantages over conventional primary closure, notably lowering surgical site infection rates and operative time. Based on these results, we recommend the Volcano technique for stoma reversal following both ileostomy and colostomy.</p>

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Primary closure versus the “Volcano” technique (PRIVEVO): a prospective observational study of purse-string wound closure for stoma reversal

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  • 发表日期：

    2026年1月24日

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  • Péter Kolozsi,
  • Kitti Nagy,
  • Tamás Felföldi,
  • Zsolt Varga,
  • Sándor Kovács,
  • Dávid Ágoston Kovács,
  • Dezső Tóth

摘要

Background

Stoma creation is an essential part of general surgery, used in procedures such as protective loop ileostomy formed during low rectal resection or coloanal anastomosis, and in Hartmann’s procedures, often performed in emergency settings. Despite its clinical importance, the optimal wound closure technique following stoma reversal remains controversial. This study aims to identify a more effective wound closure method following stoma takedown.

Methods

Between June 1, 2017, and January 31, 2020, we prospectively observed 75 patients at the University of Debrecen, Hungary, who underwent stoma closure (29 colostomies and 46 ileostomies). Among these patients, 37 underwent purse-string “Volcano” suture closure (VSC), while 38 underwent primary suture closure (PSC). We recorded demographic data, operative times, and postoperative outcomes, including wound infections. The primary endpoint was the rate of surgical site infection (SSI) in the short-term and the occurrence of postoperative hernia in the long-term period. Secondary endpoints included operative time, duration of wound dressing, and surgical complications according to the Clavien–Dindo classification. The planned follow-up period for long-term complications was 5 years. In this study, Surgical Site Infection (SSI) was defined and classified strictly according to the Centers for Disease Control and Prevention (CDC) Guideline for the Prevention of Surgical Site Infection (2017).

Results

No significant differences were observed between the VSC and PSC groups in age, sex, BMI, comorbidities, ASA classification, time from primary surgery to stoma closure, or length of hospital stay. However, the operative time was significantly shorter in the VSC group (59 min) compared to the PSC group (87 min; p = 0.034). Notably, the incidence of postoperative wound infection was 0% in the VSC group and 18.4% in the PSC group respectively (p = 0.012).

Conclusion

Our prospective observational study demonstrates that the “Volcano” (purse-string) wound closure technique provides significant advantages over conventional primary closure, notably lowering surgical site infection rates and operative time. Based on these results, we recommend the Volcano technique for stoma reversal following both ileostomy and colostomy.