Negative-Pressure Wound Dressings After Stoma Reversal: What Seven Randomised Trials Found

After stoma reversal surgery, the wound at the former stoma site is one of the most infection-prone areas in colorectal surgical recovery. Unlike a typical abdominal wound, the stoma opening has been in continuous contact with intestinal contents, which means the surrounding skin and tissue carry a much higher bacterial load than other surgical sites. The result is a surgical site infection (SSI) rate that, across studies, is meaningfully higher for stoma reversal wounds than for most other colorectal operations.

Negative-pressure wound therapy (NPWT), sometimes called vacuum-assisted closure or VAC therapy, is a wound management approach that has been used in many surgical settings. A sealed foam dressing is placed over the wound and connected to a pump that applies continuous or intermittent suction. This draws out excess fluid, reduces swelling, increases blood flow to the wound edges, and may reduce bacterial load. It has been used after stoma reversals for some years, but the evidence comparing it directly with conventional dressings has been scattered across small trials.

A 2026 research team set out to synthesise that evidence. Their GRADE-based systematic review and meta-analysis, published in BMC Surgery, drew together seven randomised controlled trials to give the clearest picture yet of whether NPWT makes a difference after stoma reversal surgery (Mirza W et al., BMC Surgery, 2026).

What the Meta-Analysis Examined

The seven trials together enrolled 429 participants: 220 who received NPWT after their stoma reversal, and 209 who received conventional dressings. The primary outcome was surgical site infection. Secondary outcomes included time to complete wound healing, length of hospital stay, operative duration, and estimated blood loss.

The researchers also prespecified subgroup analyses by the type of wound closure technique the surgeon had used: primary closure (where the skin edges are sutured together immediately) versus purse-string closure (a technique where the wound is partially left open to heal from the inside out, with the skin gathered loosely around the edges). This distinction matters clinically because the two techniques create different wound environments, and a dressing that works well in one context may not translate to the other.

The Overall Finding: A Signal, But Not Enough to Be Definitive

Pooling the data from all seven trials, NPWT was associated with a lower rate of surgical site infection compared with conventional dressings: a relative risk of 0.42 (95% confidence interval 0.14 to 1.30). However, this result did not reach statistical significance. The confidence interval crosses 1.0, which in statistical terms means the data are compatible with both a benefit and no meaningful difference. There was also a moderate degree of heterogeneity between the trials (I squared = 46%), reflecting that the studies varied in their populations, NPWT devices, conventional dressing types, and infection definitions.

The risk of bias across the included trials was rated as "some concerns," mainly because it is not practical to blind patients or care teams to whether a wound is being managed with an active NPWT device or a standard dressing. This is a common limitation in wound care research and does not mean the trials were poorly conducted, but it does add some uncertainty to the pooled estimates.

A More Specific Pattern by Closure Technique

The predefined subgroup analysis by closure technique produced a finding that changes the picture somewhat.

In patients whose stoma reversal wounds had been closed primarily, NPWT was associated with a statistically significant reduction in surgical site infection: relative risk 0.20 (95% confidence interval 0.06 to 0.67), with no heterogeneity between the trials in this group (I squared = 0%). Translated from statistics into plain terms, this suggests that among patients with primarily closed wounds, NPWT may reduce infection rates substantially.

In patients with purse-string closure, no significant difference was seen (relative risk 0.68, 95% CI 0.14 to 3.35), with higher heterogeneity (I squared = 48%).

There is an important caveat to this subgroup finding. The statistical test for whether the two groups truly differ from each other in their response to NPWT was not significant (P = 0.23). This means that while the estimates differ numerically, there is not enough evidence to say with confidence that closure technique genuinely changes whether NPWT works. The subgroup result for primary closure is a signal worth investigating further, not a confirmed finding.

The authors classify this as an exploratory observation and specifically note that larger, better-standardised randomised trials are needed before clinical recommendations can be changed.

What This Means for People Preparing for or Recovering From Stoma Reversal

Wound infection after stoma reversal is a real risk, and one that affects a meaningful proportion of patients. If you are preparing for a reversal, ask your care team about wound management before the operation, including whether NPWT is something they consider routinely for their reversal patients. The plan may or may not include NPWT, depending on your anatomy, the closure technique they intend to use, local equipment availability, and your individual risk factors.

This meta-analysis does not provide enough evidence to say that NPWT should be offered to every patient after stoma reversal. What it shows is that the question is being actively investigated, that NPWT appears to carry a promising signal especially in primarily closed wounds, and that the conversation about wound care after your reversal is one worth having with your surgical team before the operation.

If NPWT is being offered or discussed as part of your post-operative wound management, ask specifically why it is being recommended for your case. If you are told a conventional dressing will be used instead, that is also a reasonable choice supported by current practice given the limited evidence.

What matters most in the days after stoma reversal is prompt recognition of wound problems. Signs of infection include increasing redness around the wound, warmth, swelling, pain that is getting worse rather than better, discharge from the wound, or a fever. These are not signs to wait out at home. They are signs to contact your surgical team or stoma care nurse on the same day.

The NHS advises that wound complications after stoma surgery, including reversals, are recognised and treatable, and that your stoma care team is the right first point of contact for any concerns about how your wound is healing (NHS, Stoma).