Preventive Negative-Pressure Wound Therapy After Ileostomy Reversal in Colorectal Cancer

Overview

This randomized controlled trial evaluated the efficacy of postoperative negative-pressure wound therapy (NPWT) in reducing wound healing complications (WHC) and surgical site infections (SSI) following ileostomy closure in colorectal cancer patients. NPWT significantly decreased the incidence of WHC and SSI compared to standard wound care.

Background

Colorectal cancer surgeries, especially those involving the lower rectum, carry a high risk of complications including anastomotic leaks. Diverting ileostomy is commonly used to reduce leak risk but requires a second surgery for closure, which is associated with frequent wound healing complications and surgical site infections. Traditional closure techniques such as purse-string sutures reduce infection risk but prolong healing time and affect cosmetic outcomes. Negative-pressure wound therapy (NPWT) offers a potential method to combine reduced healing time with lower infection rates.

Data Highlights

Key Findings

• NPWT significantly reduced postoperative wound healing complications after ileostomy closure.
• Incidence of surgical site infections was lower in the NPWT group compared to standard care.
• NPWT allowed for fewer skin sutures due to stabilization of wound edges, reducing risk of dehiscence.
• NPWT facilitated evacuation of exudate, preventing seroma and hematoma formation.
• The study was a single-center randomized controlled trial with 76 patients equally divided between NPWT and control groups.
• NPWT combines benefits of reduced healing time and lower infection risk compared to purse-string and primary closure techniques.

Clinical Implications

Implementing NPWT after ileostomy closure in colorectal cancer patients can reduce wound healing complications and surgical site infections, potentially improving recovery and cosmetic outcomes. NPWT also allows for less dense skin suturing and effective management of wound exudate, which may decrease postoperative morbidity.

Conclusion

Postoperative NPWT is an effective intervention to mitigate wound healing complications and surgical site infections following ileostomy reversal in colorectal cancer patients, offering a superior alternative to conventional wound closure methods.

References

1. Jagiellonian University Medical College Ethics Committee 2019 -- Trial Protocol Approval
2. ClinicalTrials.gov NCT04088162 -- Trial Registration
3. Previous Observations and Pilot Study -- NPWT Reduces WHC by 70–85%