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Review
Stoma
 Comparison of purse-string technique versus linear suture for skin closure after stoma reversal: a meta-analysis of high-quality studies
Filippo Carannante1orcid, Guglielmo Niccolò Piozzi2orcid, Gianluca Costa3orcid, Valentina Miacci1orcid, Gianfranco Bianco1orcid, Vincenzo Schiavone4orcid, Jim S. Khan2orcid, Marco Caricato1orcid, Gabriella Teresa Capolupo1orcid
Annals of Coloproctology 2025;41(6):491-500.
DOI: https://doi.org/10.3393/ac.2025.00801.0114
Published online: December 31, 2025

1Colorectal Surgery Clinical and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy

2Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK

3Department of Advanced Biomedical Science, University of Naples Federico II, Naples, Italy

4Division of General Surgery, Department of Life Sciences, Health and Health Professions, Link Campus University, Rome, Italy

Correspondence to: Filippo Carannante, MD, PhD Colorectal Surgery Clinical and Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 21, Rome 00128, Italy Email: f.carannante@policlinicocampus.it
• Received: June 28, 2025   • Revised: August 25, 2025   • Accepted: September 16, 2025

© 2025 The Korean Society of Coloproctology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    Stoma reversal is associated with notable postoperative morbidity. Several techniques exist for skin closure after stoma reversal, with linear primary closure (LC) and purse-string closure (PS) being the most common. This systematic review and meta-analysis aim to compare LC and PS skin closure after stoma reversal in terms of surgical site infection (SSI) rates, wound healing, and cosmesis.
  • Methods
    In accordance with the PRISMA statement, a systematic review of skin closure after stoma reversal was conducted using MEDLINE (PubMed), Embase, Web of Science, and Scopus.
  • Results
    Eleven studies, enrolling 1,052 patients (PS, n=534; LC, n=518), published between 2006 and 2024, were included. The overall quality of the studies was considered acceptable, with a mean Jadad scale score of 4 (range, 3–5). Patients underwent ileostomy or ileostomy/colostomy in 6 and 5 studies, respectively. No differences were observed between groups in operative time, length of hospital stay, intestinal obstruction, or incisional hernia. However, SSI and overall infection rates were higher in the LC group, with a statistically significant difference for SSI.
  • Conclusion
    Skin closure following stoma reversal using the PS technique may offer advantages over LC. PS is associated with significantly lower SSI rates compared to LC. Although a large randomized controlled trial with long-term follow-up is still required, current findings suggest that PS could be considered the standard of care for wound closure after ileostomy reversal.
  • Keywords: Ileostomy; Purse-string suture; Surgical wound closure techniques; Surgical wound infection
The use of a protective stoma during rectal surgery reduces the rates of symptomatic anastomotic leakage, reoperation, and severity of complications [1–4]. However, stoma reversal carries postoperative morbidity rates ranging from 17% to 40% [1–4]. Surgical site infection (SSI) is the most frequent complication after stoma reversal, with rates reported as high as 40% [1, 2]. SSIs contribute to prolonged hospital stays and increased costs due to medication use and outpatient wound care.
At present, there is no gold standard for skin closure after stoma reversal. Multiple techniques have been described, including antibiotic skin implants [1], subcutaneous drains, iodine irrigation, and various closure methods [1–4]. The main surgical techniques are linear primary closure (LC), open-wound healing with secondary closure, delayed primary closure, and purse-string closure (PS). The PS technique, first described by Banerjee [5], involves circumferential partial approximation of the skin without complete wound closure, leaving a small defect to heal by secondary intention. This approach permits drainage and typically results in a small round scar with potentially improved cosmetic outcomes.
Despite its widespread adoption, evidence remains inconclusive regarding whether LC or PS is superior in terms of SSI rates, wound healing, and cosmetic results. This systematic review and meta-analysis aimed to compare LC and PS skin closure after stoma reversal with respect to SSI, healing, and cosmesis.
Literature search strategy
This systematic review was conducted in accordance with the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines [6] to identify studies comparing surgical outcomes of LC and PS skin closure after stoma reversal. All PRISMA steps were performed independently by 2 authors (FC and GC). Any discrepancies or final decisions on study eligibility were resolved by consensus.
Identification and screening
This study was registered in PROSPERO (No. CRD42024568601). A systematic search was conducted in MEDLINE (PubMed), Embase, Web of Science, and Scopus to identify studies comparing outcomes of PS versus LC for wound closure following ileostomy or colostomy reversal. The following search terms were applied: (purse string OR purse-string OR purse) AND (stoma OR ileostomy OR colostomy), without restrictions on sex or language. Restrictions were applied to include only human studies, published in English, up to August 20, 2024. Titles of the retrieved studies were screened, and duplicates were removed. Titles and abstracts were then reviewed manually using predetermined inclusion and exclusion criteria. For studies meeting the initial screening criteria, full-text articles were retrieved and evaluated for relevance. Nonretrievable studies were excluded. A supplementary manual search was also performed in Google Scholar, and reference lists of retrieved manuscripts were reviewed to identify additional relevant studies. Records were managed using Mendeley Desktop ver. 1.19.4 (Elsevier) and Covidence (Covidence).
Eligibility criteria
Studies were selected according to the PICOS (population, intervention, comparison, outcomes, and study design) framework [7]. Only randomized controlled trials (RCTs) comparing PS with LC after stoma reversal were included. At least one perioperative outcome of interest was required, regardless of follow-up duration. Studies were excluded from the quantitative analysis if the number of patients or outcomes of interest in each group could not be extracted. Case series with retrospective designs, case reports, technical notes, and video reports were also excluded. When multiple papers were published by the same group of authors over time, all were reviewed, but only the most recent, informative, or highest-quality study was included.
Data extraction and quality assessment
Following the eligibility criteria, 2 reviewers (FC and GC) independently assessed each study to minimize selection bias. Study quality was evaluated using the Jadad scale for RCTs [8], and data extraction was performed in parallel. Disagreements were resolved through consensus with a third reviewer (GTC).
The following demographic variables were collected when available: age, sex distribution, body mass index, American Society of Anesthesiologists (ASA) physical status, indication for surgery, diabetes mellitus, renal failure, smoking status, and preoperative immunosuppression. Surgical outcomes assessed included operative time, hospital length of stay (LOS), prolonged ileus and/or intestinal obstruction, SSI, and overall infection rate. Intraoperative and postoperative complications were reported quantitatively and qualitatively whenever possible.
Statistical analysis
The analysis followed the Cochrane Handbook for Systematic Reviews of Interventions [9]. Continuous variables were analyzed using the weighted mean difference (WMD) with 95% confidence intervals (CIs). Categorical variables were assessed using odds ratios (OR) with 95% CI. For variables reported as median with range or interquartile range, values were converted to mean and standard deviation, according to Hozo et al. [10]. Subgroup analyses were conducted for studies limited to ileostomy closure and for mixed series where colostomy and ileostomy reversal were not separately reported. Heterogeneity was assessed using the I2 statistic. An I2 value of ≤40% was considered trivial or unimportant, and ≥75% was considered considerable heterogeneity. When I2 exceeded 50%, pooled estimates were generated using a random-effects model. For the Q index (chi-square test of heterogeneity), P<0.10 was considered significant; otherwise, P<0.05 was regarded as statistically significant. Publication bias was assessed using funnel plot asymmetry, with the Egger test [11] for continuous outcomes and with the Harbord test [12] for binary outcomes. Statistical analysis was carried out using Stata ver. 16 (Stata Corp).
Literature search and general review
A total of 334 studies were identified. After duplicate removal and title and abstract screening, 57 full-text papers were evaluated. Thirteen studies were deemed eligible (Fig. 1), and 11 studies were included [13–23], enrolling 1,052 patients (PS, n=534; LC, n=518). The studies were conducted in Australia (n=1), Germany (n=1), Mexico (n=1), Switzerland and the United States (n=1), the Philippines (n=1), Iran (n=1), Japan (n=2), Ireland (n=1), India (n=1), and Italy (n=1). Ten studies were prospective RCTs, and one included a propensity score matching analysis. All but one was single-center studies, with one having a multicenter design. Patient recruitment occurred between 2006 and 2021, and publications ranged from 2010 to 2024. The overall quality of the included studies was considered acceptable, with a mean Jadad scale score of 4 (range, 3 to 5).
In 6 studies, only patients with ileostomies were included, while 5 studies included patients with either ileostomy or colostomy. All studies examined patients with colorectal cancer or benign conditions (diverticular disease or inflammatory bowel disease) who underwent bowel resection with stoma creation and subsequently required stoma reversal. Patient characteristics and surgical details are summarized in Tables 1 and 2 [13–23].
Comparison of outcomes of interest
Because patient satisfaction (both aesthetic and overall) was assessed using different methods across studies, only qualitative descriptions of these outcomes are presented in Table 2 [13–23].
Operative time
Eight studies with 734 patients (PS, n=375; LC, n=359) reported operative time [14–17, 19–22]. Pooled analysis showed no difference between groups (WMD, 1.046; 95% CI, –2.462 to 4.555; P=0.559) (Fig. 2A) [14–17, 19–22]. No heterogeneity was observed (I2=0%, P=0.518) (Fig. 3A). Publication bias assessment using the Egger linear regression test showed no asymmetry (Y intercept, –0.83; P=0.408).
Length of stay
Seven studies including 630 patients (PS, n=321; LC, n=309) analyzed postoperative LOS [14–17, 20, 22, 23]. No statistically significant difference in LOS was found (WMD, –0.874; 95% CI, –2.207 to 0.459; P=0.199) (Fig. 2B) [14–17, 20, 22, 23]. Considerable heterogeneity was observed (I2=81.24%, P<0.001), mainly due to the findings of Yamamoto et al. [20]. Therefore, a random-effects model was applied. Funnel plot analysis showed asymmetry, with Egger regression test significant at Y intercept –4.04 (P<0.001) (Fig. 3B).
Surgical site infection
All studies reported SSI outcomes, involving 950 participants (PS, n=534; LC, n=416) [13–23]. Pooled analysis demonstrated a statistically significant lower risk of SSI in the PS group (logOR, –1.819; 95% CI, –2.281 to –1.358; P<0.001). No heterogeneity was detected (I2=0%, P=0.624) (Fig. 2C) [13–23]. The Harbord test for funnel plot asymmetry was not significant (Y intercept, –0.68; P=0.493) (Fig. 3C).
Overall infection
Two studies with 230 participants (PS, n=116; LC, n=114) reported overall infection rates [14, 23]. A statistically significant lower risk was observed in the PS group (logOR, –0.837; 95% CI, –1.480 to –0.194; P=0.011). No heterogeneity was observed (I2=0.00%, P=0.719) (Fig. 2D) [14, 23]. The Harbord test for funnel plot asymmetry was not significant (Y intercept, 0.34; P=0.736) (Fig. 3D).
Intestinal obstruction
Three studies including 262 patients (PS, n=132; LC, n=130) reported intestinal obstruction as an outcome [16, 21, 23]. No significant difference between groups was found (logOR, 0.176; 95% CI, –0.746 to 1.089; P=0.708). No heterogeneity was detected (I2=0%; P=0.757) (Fig. 2E) [16, 21, 23]. The Harbord test for funnel plot asymmetry was not significant (Y intercept, 1.03; P=0.303) (Fig. 3E).
Incisional hernia
Five studies including 474 patients (PS, n=239; LC, n=235) analyzed incisional hernia rates [13, 16, 18, 20, 21]. Pooled analysis showed a nonsignificant trend toward lower hernia risk in the PS group (logOR, –0.656; 95% CI, –1.341 to 0.029; P=0.061). No heterogeneity was detected (I2=0.00%; P=0.510) (Fig. 2F) [13, 16, 18, 20, 21]. The Harbord test for funnel plot asymmetry was not significant (Y intercept, –1.56; P=0.118) (Fig. 3F).
This meta-analysis included 11 high-quality studies [13, 16–23] comparing surgical outcomes between PS and LC closure techniques following stoma reversal. The available evidence demonstrates that PS significantly reduces SSI rates without affecting operative duration, LOS, incisional hernia rates, or postoperative obstruction. PS closure offers advantages in SSI prevention. Stoma reversal carries a high risk of SSI due to skin contamination around the stoma site and potential exposure to intestinal contents [24, 25]. The PS technique leaves a central opening of 0.5 to 1 cm, which prevents fluid accumulation and allows continuous drainage of exudate [26]. The wound heals secondarily through granulation and may provide superior cosmetic results. In contrast, LC involves complete closure of the wound; trapped subcutaneous exudate may not drain effectively, increasing the risk of abscess formation from bacterial contamination [27]. Higher SSI rates are linked with increased risk of incisional hernia, prolonged LOS, and greater medical costs. Although this analysis did not reveal a statistically significant difference in LOS, a correlation between SSI and incisional hernia incidence suggests that inadequate drainage may play a role. A meta-analysis by Li et al. [28] similarly found PS to be the most effective closure method for preventing SSI, outperforming closure with drains, secondary closure, loose primary closure, and delayed primary closure.
The most recent systematic review prior to this analysis was conducted by Rondelli et al. [29] in 2018. They identified PS as the best closure technique for reducing SSI, based on 5 RCTs, but found no significant differences between PS and LC in operative time, LOS, incisional hernia, or intestinal obstruction. Unlike Rondelli et al. [29], which considered only RCTs, the strength of our analysis lies in the inclusion of the latest high-quality studies, 10 RCTs and 1 propensity score–matched study, while excluding observational designs. The total sample size increased to 1,052 patients, with 534 in the PS group and 518 in the LC group. Six outcomes were analyzed, providing more robust and less biased evidence. Although 6 studies reported cosmetic outcomes, the considerable heterogeneity in study design and outcome assessment precluded a reliable meta-analysis of cosmesis.
Limitations
This study has several limitations. First, the included trials involved relatively small sample sizes, limiting statistical power to detect small differences in outcomes. Second, none of the trials provided long-term follow-up data. Incisional hernia, which typically occurs an average of 9 months after stoma reversal, was reported in only 5 studies [25]. Third, this meta-analysis did not evaluate cost-effectiveness. SSI represents a significant economic burden through prolonged LOS, additional medications, and higher treatment costs [30]. However, because healthcare costs differ across countries, each health system requires its own cost-effectiveness analysis to support decision-making.
Conclusions
Skin closure following stoma reversal with the PS technique appears more advantageous than LC. PS is associated with significantly lower rates of SSI compared with LC. Although a large RCT with long-term follow-up is still needed, current evidence suggests that PS closure could be considered the standard of care for wound closure after ileostomy reversal.

Conflict of interest

Jim S. Khan performs proctoring for Intuitive Surgical and educational activity with Johnson & Johnson. No other potential conflict of interest relevant to this article was reported.

Funding

None.

Author contributions

Conceptualization: FC, GC, GTC, MC, JSK; Formal analysis: FC, GC, VS, VM, GNP, GB; Investigation: FC, GC, VS, VM, GNP, GB; Methodology: FC, GC, GTC; Supervision: GTC; Validation: MC, JSK; Writing–original draft: FC, GC, GTC; Writing–review & editing: all authors. All authors read and approved the final manuscript.

Fig. 1.
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) study flowchart.
ac-2025-00801-0114f1.jpg
Fig. 2.
Forest plots of the meta-analysis for (A) operative time, (B) length of stay, (C) surgical site infection, (D) overall infections, (E) intestinal obstruction, and (F) incisional hernia. SD, standard deviation; MD, mean difference; CI, confidence interval; OR, odds ratio.
ac-2025-00801-0114f2.jpg
Fig. 3.
Funnel plots of (A) operative time (I2=0%, P=0.518), (B) length of stay (I2=81.24%, P<0.001), (C) surgical site infection (I2=0%, P=0.624), (D) overall infections (I2=0%, P=0.719), (E) intestinal obstruction (I2=0%, P=0.757), and (F) incisional hernia (I2=0%, P=0.510). OR, odds ratio.
ac-2025-00801-0114f3.jpg
Table 1.
Characteristics of the studies included in the meta-analysis
Study Country Study design Jadad scale score Stoma type Prophylactic antibiotic use Postoperative antibiotic use Fascia closure material Follow-up (mo)
Reid et al. [15] (2010) Australia RCT 4 Ileostomy Yes NA 1/0 PDS (Ethicon) 12
Dusch et al. [16] (2013) Germany RCT 4 Ileostomy Yes NA Vicryl 2 (Ethicon) 6
Camacho-Mauries et al. [21] (2013) Mexico RCT 4 Ileostomy/colostomy Yes NA 1/0 Polyglactin 910 12
Lee et al. [14] (2014) Switzerland and USA RCT 4 Ileostomy/colostomy Yes No NA 1
Lopez et al. [13] (2015) Philippines RCT 4 Ileostomy/colostomy Yes No Absorbable braided suture 1
Alvandipour et al. [22] (2016) Iran RCT 4 Ileostomy NA NA 1/0 PDS (Ethicon) 3
Yamamoto et al. [20] (2018) Japan PSM analysis 4 Ileostomy Yes NA Absorbable suture 72 (12–195)a
O'Leary et al. [17] (2017) Ireland RCT 3 Ileostomy Yes NA 0 PDS (Ethicon) 6
Sureshkumar et al. [18] (2018) India RCT 4 Ileostomy/colostomy Yes NA NA 3
Amano et al. [19] (2019) Japan RCT 4 Ileostomy/colostomy Yes Single dose after surgery 2-0 Absorbable suture 1
Carannante et al. [23] (2024) Italy RCT 5 Ileostomy Yes NA Vicryl 2 (Ethicon) 12

RCT, randomized controlled trial; NA, not available; PDS, polydioxanone; PSM, propensity score matching

aMedian (range).

Table 2.
Patient characteristics of the studies included in the meta-analysis according to surgical procedure
Study No. of patients Age (yr) Male sex BMI (kg/m2) Primary endpoint Skin closure material Cosmetic outcome
Reid et al. [15] (2010) SSI
 PS 30 62.3±11.0 18 (60.0) 26.3±4.9 1/0 Prolene (Ethicon) 7.8±1.5/10
 LC 31 57.1±17.8 27 (87.1) 24.9±5.0 3/0 Autosuture Caprosyn (Covidien) 7.4±0.9/10
Dusch et al. [16] (2013) SSI
 PS 43 62.2±14.0 27 (62.8) 25.1±4.09 2/0 Prolene (Ethicon) 16 (10–24)
 LC 41 57.6±15.7 28 (68.3) 24.3±4.73 3/0 Seralon (Serag Wiessner) 16 (8–24)
Camacho-Mauries et al. [21] (2013) SSI NA
 PS 31 49.3±16.2 21 (67.7) 23.4±4.85 0/0 Polypropylene
 LC 30 48.3±16.0 18 (60.0) 24.8±5.75 2/0 Polypropylene
Lee et al. [14] (2014) NA SSI
 PS 58 56.1±15.0 29 (50.0) 2/0 Absorbable monofilament 4.3±0.4/5
 LC 55 53.2±14.0 30 (54.5) Staples or nonabsorbable suture 4.0±0.8/5
Lopez et al. [13] (2015) NA SSI
 PS 61 46.0±14.5 36 (59.0) Absorbable monofilament 5 (0–5)
 LC 60 47.0±13.0 43 (71.7) Nonabsorbable suture 5 (0–5)
Alvandipour et al. [22] (2016) SSI NA
 PS 34 53.3±13.6 19 (55.9) 24.4±2.6 0/2 Vicryl suture
 LC 32 52.9±14.0 16 (50.0) 24.3±2.3 3/0 Nylon suture
Yamamoto et al. [20] (2018) SSI NA
 PS 64 61 (18–82) 46 (71.9) 21.5 (16.9–30.2) Absorbable multifilament
 LC 64 61 (33–87) 38 (59.4) 21.4 (15.6–34.0) Nonabsorbable monofilament
O'Leary et al. [17] (2017) SSI NA
 PS 34 60.7±13.4 19 (55.9) 25.8±4.7 3/0 Monocryl (Ethicon)
 LC 27 59.3±13.5 17 (63.0) 26.3±4.6 3/0 Monocryl (Ethicon)
Sureshkumar et al. [18] (2018) SSI
 PS 40 50.1±16.2 20 (50.0) 23.9±4.8 Absorbable suture 5.05±1.39/10
 LC 40 43.4±16.0 28 (70.0) 23.7±3.0 Nonabsorbable suture 5.03±1.40/10
Amano et al. [19] (2019) NA SSI NA
 PS 80 62 (18–82) 47 (58.8) 2-0 Absorbable suture
 LC 79 64 (18–83) 45 (57.0) 3-0 Nonabsorbable suture
Carannante et al. [23] (2024) NA SSI
 PS 58 66.50±13.74 31 (53.4) 2/0 Monocryl (Ethicon) 4.02±0.73/5
 LC 59 64.88±14.96 31 (52.5) 2/0 Nylon 2.39±0.73/5

Values are presented as number only, mean±standard deviation, number (%), or median (range).

BMI, body mass index; SSI, surgical site infection; PS, purse-string closure; LC, linear primary closure; NA, not available.

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        Comparison of purse-string technique versus linear suture for skin closure after stoma reversal: a meta-analysis of high-quality studies
        Ann Coloproctol. 2025;41(6):491-500.   Published online December 31, 2025
        DOI: https://doi.org/10.3393/ac.2025.00801.0114
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      Comparison of purse-string technique versus linear suture for skin closure after stoma reversal: a meta-analysis of high-quality studies
      Image Image Image
      Fig. 1. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) study flowchart.
      Fig. 2. Forest plots of the meta-analysis for (A) operative time, (B) length of stay, (C) surgical site infection, (D) overall infections, (E) intestinal obstruction, and (F) incisional hernia. SD, standard deviation; MD, mean difference; CI, confidence interval; OR, odds ratio.
      Fig. 3. Funnel plots of (A) operative time (I2=0%, P=0.518), (B) length of stay (I2=81.24%, P<0.001), (C) surgical site infection (I2=0%, P=0.624), (D) overall infections (I2=0%, P=0.719), (E) intestinal obstruction (I2=0%, P=0.757), and (F) incisional hernia (I2=0%, P=0.510). OR, odds ratio.

      Fig. 1.

      Fig. 2.

      Fig. 3.

      Comparison of purse-string technique versus linear suture for skin closure after stoma reversal: a meta-analysis of high-quality studies
      Study Country Study design Jadad scale score Stoma type Prophylactic antibiotic use Postoperative antibiotic use Fascia closure material Follow-up (mo)
      Reid et al. [15] (2010) Australia RCT 4 Ileostomy Yes NA 1/0 PDS (Ethicon) 12
      Dusch et al. [16] (2013) Germany RCT 4 Ileostomy Yes NA Vicryl 2 (Ethicon) 6
      Camacho-Mauries et al. [21] (2013) Mexico RCT 4 Ileostomy/colostomy Yes NA 1/0 Polyglactin 910 12
      Lee et al. [14] (2014) Switzerland and USA RCT 4 Ileostomy/colostomy Yes No NA 1
      Lopez et al. [13] (2015) Philippines RCT 4 Ileostomy/colostomy Yes No Absorbable braided suture 1
      Alvandipour et al. [22] (2016) Iran RCT 4 Ileostomy NA NA 1/0 PDS (Ethicon) 3
      Yamamoto et al. [20] (2018) Japan PSM analysis 4 Ileostomy Yes NA Absorbable suture 72 (12–195)a
      O'Leary et al. [17] (2017) Ireland RCT 3 Ileostomy Yes NA 0 PDS (Ethicon) 6
      Sureshkumar et al. [18] (2018) India RCT 4 Ileostomy/colostomy Yes NA NA 3
      Amano et al. [19] (2019) Japan RCT 4 Ileostomy/colostomy Yes Single dose after surgery 2-0 Absorbable suture 1
      Carannante et al. [23] (2024) Italy RCT 5 Ileostomy Yes NA Vicryl 2 (Ethicon) 12
      Study No. of patients Age (yr) Male sex BMI (kg/m2) Primary endpoint Skin closure material Cosmetic outcome
      Reid et al. [15] (2010) SSI
       PS 30 62.3±11.0 18 (60.0) 26.3±4.9 1/0 Prolene (Ethicon) 7.8±1.5/10
       LC 31 57.1±17.8 27 (87.1) 24.9±5.0 3/0 Autosuture Caprosyn (Covidien) 7.4±0.9/10
      Dusch et al. [16] (2013) SSI
       PS 43 62.2±14.0 27 (62.8) 25.1±4.09 2/0 Prolene (Ethicon) 16 (10–24)
       LC 41 57.6±15.7 28 (68.3) 24.3±4.73 3/0 Seralon (Serag Wiessner) 16 (8–24)
      Camacho-Mauries et al. [21] (2013) SSI NA
       PS 31 49.3±16.2 21 (67.7) 23.4±4.85 0/0 Polypropylene
       LC 30 48.3±16.0 18 (60.0) 24.8±5.75 2/0 Polypropylene
      Lee et al. [14] (2014) NA SSI
       PS 58 56.1±15.0 29 (50.0) 2/0 Absorbable monofilament 4.3±0.4/5
       LC 55 53.2±14.0 30 (54.5) Staples or nonabsorbable suture 4.0±0.8/5
      Lopez et al. [13] (2015) NA SSI
       PS 61 46.0±14.5 36 (59.0) Absorbable monofilament 5 (0–5)
       LC 60 47.0±13.0 43 (71.7) Nonabsorbable suture 5 (0–5)
      Alvandipour et al. [22] (2016) SSI NA
       PS 34 53.3±13.6 19 (55.9) 24.4±2.6 0/2 Vicryl suture
       LC 32 52.9±14.0 16 (50.0) 24.3±2.3 3/0 Nylon suture
      Yamamoto et al. [20] (2018) SSI NA
       PS 64 61 (18–82) 46 (71.9) 21.5 (16.9–30.2) Absorbable multifilament
       LC 64 61 (33–87) 38 (59.4) 21.4 (15.6–34.0) Nonabsorbable monofilament
      O'Leary et al. [17] (2017) SSI NA
       PS 34 60.7±13.4 19 (55.9) 25.8±4.7 3/0 Monocryl (Ethicon)
       LC 27 59.3±13.5 17 (63.0) 26.3±4.6 3/0 Monocryl (Ethicon)
      Sureshkumar et al. [18] (2018) SSI
       PS 40 50.1±16.2 20 (50.0) 23.9±4.8 Absorbable suture 5.05±1.39/10
       LC 40 43.4±16.0 28 (70.0) 23.7±3.0 Nonabsorbable suture 5.03±1.40/10
      Amano et al. [19] (2019) NA SSI NA
       PS 80 62 (18–82) 47 (58.8) 2-0 Absorbable suture
       LC 79 64 (18–83) 45 (57.0) 3-0 Nonabsorbable suture
      Carannante et al. [23] (2024) NA SSI
       PS 58 66.50±13.74 31 (53.4) 2/0 Monocryl (Ethicon) 4.02±0.73/5
       LC 59 64.88±14.96 31 (52.5) 2/0 Nylon 2.39±0.73/5
      Table 1. Characteristics of the studies included in the meta-analysis

      RCT, randomized controlled trial; NA, not available; PDS, polydioxanone; PSM, propensity score matching

      Median (range).

      Table 2. Patient characteristics of the studies included in the meta-analysis according to surgical procedure

      Values are presented as number only, mean±standard deviation, number (%), or median (range).

      BMI, body mass index; SSI, surgical site infection; PS, purse-string closure; LC, linear primary closure; NA, not available.

      Table 1.

      Table 2.

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