Comparison of linear and purse-string suture techniques for stoma closure.

Stoma Closure Face-Off: Is Purse-String Suture the New Champ?

Soraya Malik in Health & Wellness November 2025 • 4 min read.

"Ditch the Linear Scar? A new study compares purse-string and traditional skin closure techniques for ileostomy reversal, revealing surprising insights into wound infection rates and cosmetic outcomes."

If you're facing ileostomy reversal, you're likely thinking about a smooth recovery and the best possible cosmetic outcome. Traditionally, surgeons have used a linear skin closure technique, resulting in a straight scar. But there's a growing interest in purse-string skin closure—a method that aims to minimize wound complications and leave a smaller, more discreet scar.

Wound infection is a common concern after ileostomy reversal, with rates varying widely. To combat this, the purse-string closure technique has emerged as an alternative. A recent study directly compared the effectiveness of linear versus purse-string skin closure in patients undergoing loop ileostomy reversal. This article breaks down the study's findings, offering clarity on which method might lead to fewer complications and better results.

This comprehensive guide examines the key aspects of both techniques, from surgical procedures to recovery times, empowering you with the knowledge to discuss the best options with your healthcare provider. We will explore the details of the study and discuss the potential benefits and drawbacks of each method.

Purse-String vs. Linear Closure: What the Study Reveals

Comparison of linear and purse-string suture techniques for stoma closure.

A study published in the Journal of the Korean Society of Coloproctology compared wound infection rates and operative outcomes between linear and purse-string skin closures following loop ileostomy reversal. The researchers retrospectively analyzed 48 patients who underwent loop ileostomy reversal between December 2002 and October 2010. Thirty patients received linear skin closure (Group L), while 18 patients underwent purse-string closure (Group P).

The study meticulously collected data on various factors, including patient demographics, operative times, hospital stays, and, most importantly, wound infection rates. Here's a breakdown of the key elements of each surgical technique:

Linear Skin Closure (Group L): An elliptical incision was made around the stoma. After ileum mobilization and anastomosis, the rectus fascia was repaired with interrupted sutures. The skin was then closed using vertical mattress interrupted sutures, resulting in a traditional linear scar.
Purse-String Skin Closure (Group P): A circumstomal incision was made around the ileostomy. The fascial closure was identical to the linear closure technique. However, instead of linear sutures, the circumstomal skin incision was approximated using a purse-string subcuticular suture (2-0 Polysorb), effectively drawing the skin together in a circular fashion.

The study found that the median operative time was similar between the two groups: 103 minutes for Group L and 100 minutes for Group P. However, a significant difference emerged in hospital stays. Group L had a median hospital stay of 11 days, while Group P's median stay was only 7 days (P < 0.001). As for the wound infection, in group L, 5 cases out of 30 participants (16.7%) had wound infections. However, in group P, only 1 case out of 18 participants (5.6%) had wound infection, which was considered not statistically significant (P = 0.26).

The Verdict: Is Purse-String Closure Right for You?

The study suggests that purse-string skin closure after loop ileostomy reversal offers comparable outcomes in terms of wound infection rates compared to linear skin closure. While the study didn't find a statistically significant difference in wound infection rates, the shorter hospital stay associated with purse-string closure is a notable advantage. Moreover, the potential for a smaller, more aesthetically pleasing scar makes it an attractive option for many patients. While it is not significantly proven to be more effective in reducing the wound infection, purse-string skin closure could be a good alternative to the conventional linear closure.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.3393/jksc.2011.27.2.58, Alternate LINK

Title: Conventional Linear Versus Purse-String Skin Closure After Loop Ileostomy Reversal: Comparison Of Wound Infection Rates And Operative Outcomes

Journal: Journal of the Korean Society of Coloproctology

Publisher: Korean Society of Coloproctology

Authors: Jung Ryeol Lee, Young Wan Kim, Jong Je Sung, Ok-Pyung Song, Hyung Chul Kim, Cheol-Wan Lim, Gyu-Seok Cho, Jun Chul Jung, Eung-Jin Shin

Published: 2011-01-01

Everything You Need To Know

1

What are the key differences between linear skin closure and purse-string skin closure techniques in ileostomy reversal?

A linear skin closure involves making an elliptical incision around the stoma, followed by rectus fascia repair with interrupted sutures. The skin is then closed using vertical mattress interrupted sutures, resulting in a traditional linear scar. Conversely, the purse-string skin closure uses a circumstomal incision around the ileostomy. The fascial closure is similar to the linear closure technique, but the skin incision is approximated using a purse-string subcuticular suture (2-0 Polysorb), drawing the skin together in a circular fashion. While both techniques address ileostomy reversal, they differ significantly in how the skin is closed, which impacts scarring and potential complications.

2

What did the study reveal about the outcomes of purse-string vs. linear closure following loop ileostomy reversal?

The study published in the *Journal of the Korean Society of Coloproctology* showed that while the operative time was similar between linear skin closure (Group L) and purse-string skin closure (Group P), the median hospital stay was significantly shorter for Group P (7 days) compared to Group L (11 days). Wound infection rates were 16.7% in Group L and 5.6% in Group P, but this difference was not statistically significant. Therefore, purse-string skin closure could be a good alternative to the conventional linear closure.

3

Although purse-string closure appears advantageous, what are the limitations or considerations regarding its effectiveness compared to linear closure?

While the study indicated a shorter hospital stay with purse-string skin closure, it did not find a statistically significant difference in wound infection rates compared to linear skin closure. This means that although purse-string closure may offer benefits like a smaller scar and potentially quicker recovery, its superiority in preventing infections isn't definitively proven. Surgeons consider factors beyond infection rates when choosing a closure method, such as the patient's overall health, the complexity of the ileostomy reversal, and their experience with each technique.

4

What is the purpose of the purse-string subcuticular suture (2-0 Polysorb) in the purse-string closure technique, and how does it contribute to the outcome?

The purse-string subcuticular suture (2-0 Polysorb) is used in purse-string skin closure to approximate the circumstomal skin incision. It's designed to draw the skin together in a circular fashion, aiming to minimize scarring and promote better cosmetic outcomes. By using a continuous suture that cinches the skin closed, the tension is distributed more evenly, which can reduce the risk of wound dehiscence and improve the aesthetic appearance of the scar compared to traditional linear closures that use interrupted sutures.

5

How should patients approach the decision-making process when choosing between linear skin closure and purse-string skin closure for ileostomy reversal?

Choosing between linear skin closure and purse-string skin closure involves considering factors like the potential for a shorter hospital stay (observed with purse-string closure), the desire for a smaller, more discreet scar (a benefit of purse-string closure), and the surgeon's expertise with each technique. While the study suggests comparable wound infection outcomes, individual patient factors and preferences play a crucial role in the decision-making process. Patients should discuss the potential advantages and disadvantages of each method with their surgeon to determine the best approach for their specific situation, balancing cosmetic outcomes with recovery time and infection risk.