Wound Healing After Stoma Reversal: What a 2024 Cochrane Review Found

For many people who live with a stoma, reversal is a possibility they hold onto. Not everyone will be a candidate, and the timing depends on individual circumstances and the original reason for the surgery, but it remains one of the most common questions people bring to their care teams: could this be undone?

If and when reversal becomes an option, there is a specific surgical detail that has attracted considerable research attention, and that patients rarely know to ask about: how the wound left by the stoma opening is closed afterward. A 2024 Cochrane systematic review and meta-analysis examined exactly this question, comparing two skin closure techniques and their effect on wound infection rates after stoma reversal (Hajibandeh S, Hajibandeh S, Maw A, Cochrane Database of Systematic Reviews, 2024).

Two Ways to Close the Same Wound

When a surgeon reverses a stoma, they reconnect the bowel and then face a practical problem: the circular skin opening left where the stoma emerged now needs to be closed. There are two main techniques.

The first is linear closure. The circular opening is trimmed to an elliptical shape and closed with sutures in a straight line, similar to any other surgical wound. This is the more traditional approach.

The second is purse-string closure. A suture is passed in a circular fashion around the inside edge of the wound and, when drawn closed, gathers the skin inward. This leaves a small central opening of roughly one to two centimetres, which is not sutured shut. Instead, it is packed with a dressing and left to heal from the inside out, by a process called secondary intention, over several weeks.

The reason these two techniques matter is contamination. The stoma site sits where the bowel was brought to the surface of the abdomen, and bacteria from the bowel are inevitably present in and around that tissue. A sutured linear wound traps contaminated tissue beneath a closed surface, creating conditions that can favour infection. Purse-string closure avoids this by leaving a channel for drainage and allowing the wound to heal progressively inward.

What the Cochrane Review Found

The 2024 Cochrane review pooled evidence from randomised controlled trials comparing these two approaches and found that purse-string skin closure was associated with a significant reduction in surgical site infection compared with linear closure in people undergoing stoma reversal (Hajibandeh S et al., Cochrane Database of Systematic Reviews, 2024). Cochrane systematic reviews synthesise findings from multiple controlled trials and are considered among the highest-quality evidence in medicine.

Surgical site infection after stoma reversal is a recognised complication. When it occurs, it typically becomes apparent in the days following discharge, causing pain, swelling, and sometimes wound breakdown that may require further management. Recovery can be extended meaningfully when infection occurs.

The NHS acknowledges that stoma reversal carries its own recovery period and potential complications, including wound infection, and that whether reversal is possible depends on individual circumstances (NHS, Ileostomy reversal). The 2024 Cochrane evidence adds a specific, evidence-based dimension to that picture: the technique used to close the wound is not a minor detail.

What This Means as a Patient

The choice of closure technique is a surgical decision made by your team in the context of your specific anatomy, the type of stoma you have, and factors relevant to your procedure. Not every technique is appropriate for every situation, and your surgeon will weigh several considerations alongside the evidence.

What the evidence does give you is a basis for an informed conversation. If stoma reversal is something you are planning or currently discussing with your surgeon, it is reasonable to ask about wound closure plans and what the reasoning is. Understanding the options is part of being an active participant in your care.

Purse-string closure does involve tradeoffs. The wound takes longer to heal, with several weeks of dressing changes rather than a simple suture removal. The resulting scar tends to be circular rather than linear. These are considerations your surgical team will weigh alongside infection risk.

Understanding the evidence does not mean second-guessing surgical decisions. It means being in a position to ask the right questions.

Consult your doctor or surgical team before making any decisions about stoma reversal or surgical care based on information you have read online, including this article.