***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction Stoma closure is one of the most frequently performed surgeries . The common complications are surgical site infection ( SSI ) and poor scar cosmesis .  Purse-string sutures are expected to have less incidence of SSI due to the free drainage of secretions from the wound and possibly the early detection of a wound infection . Compared to the conventional linear closure , the purse-string closure technique is expected to have less wound infection , improved scar cosmesis , and good patient satisfaction because of a smaller size scar . Hence , a well-structured study is required to substantiate the advantage of this technique . Methodology This r and omized control trial was carried out for two years in a tertiary care centre in Southern India . Patients with various stoma reversals , including colostomy , as well as ileostomy reversal , were included in the study . Patients were divided into Group I - conventional linear skin suturing ( n = 40 ) and Group II - purse-string closure ( n = 40 ) . After the closure of rectus muscle , the skin is closed using the purse-string method ( subcuticular ) in the experimental group . Results Both the groups were comparable with respect to age , gender , body mass index ( BMI ) , the presence of co-morbidities , and indication for surgery . Stomal procedures were done ( 26.3 % ) for malignant cases . The difference in mean hospital days for both groups were statistically insignificant ( 11.95 vs. 9.9 ; p = 0.927 ) . The incidence of SSI between the groups were statistically significant ( 17 vs. 3 ; p = 0.003 ) . The mean Patient and Observer Scar Assessment Scoring ( POSAS ) scores between the groups ( 65.30 vs. 83.40 ; p = 0.012 ) were statistically significant . This proved significant improvement in scar cosmesis in purse-string skin closure . At one month postoperative , the purse-string group had better patient satisfaction ( 3.08 vs. 4.48 ; p = 0.001 ) , which was evidence d by a mean Likert 3 scale score . The mean visual analogue scale ( VAS ) score did not show any significant difference in pain between the groups . Conclusion Purse-string skin closure for stoma reversal had significantly less incidence of SSI . The duration of antibiotic therapy was also less in purse-string skin closure patients as compared to linear skin closure patients . Purse-string skin closures significantly improved the scar outcome and patient satisfaction Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background The creation of a stoma is commonplace in colorectal surgery . Circumferential subcuticular wound approximation ( CSWA ) is a method of wound closure following stoma reversal that has been reported to result in decreased wound infection rates and more desirable aesthetic outcomes . The aim of the present study was to determine the effectiveness of the CSWA method , in terms of wound infection and cosmesis by comparing the technique to the conventional method of wound closure . Methods All adult patients who presented for stoma reversal at the outpatient clinic of the Division of Colorectal Surgery at the Philippine General Hospital were r and omized into two groups , CSWA and conventional . Patients were followed up for up to 30 days postoperatively , photographic documentation of wound appearance was obtained , and wound infections and complications were documented . Patients were asked to complete a satisfaction survey at the end of the follow-up period . Results A total of 121 patients were included in the study . One ( 1.6 % ) patient in the CSWA group developed wound infection , while six ( 10 % ) patients in the conventional group had a wound infection ( p = 0.061 ) . The CSWA group had a higher total satisfaction score than the conventional group ( 25 and 24 , respectively , p = 0.012 ) . Conclusions With regard to wound infection rates , the CSWA method was better than the conventional method , although this was found to be borderline significant . With regard to patient satisfaction , the CSWA method proved to be superior to the conventional method , and this was found to be statistically significant . In addition , the technique is applicable to all forms of stoma regardless of the bowel segment involved , trephine size , and indication for diversion Purpose Infection is one of the most frequent complications that can occur after ileostomy closure . The incidence of wound infection depends on the skin closure technique , but there is no agreement on the perfect closure method for an ileostomy wound . The aim of this study was to evaluate the incidence of infection , the patient 's approval , and the patient 's pain between purse-string closure ( PSC ) and the usual linear closure ( LC ) of a stoma wound . Methods This r and omized clinical trial enrolled 66 patients who underwent a stoma closure from February 2015 to May 2015 in Sari Emam Khomeini Hospital . Patients were divided into 2 groups according to the stoma closing method : the PSC group ( n = 34 ) and the LC group ( n = 32 ) . The incidences of infection for the 2 groups were compared , and the patients ' satisfaction and pain with the stoma were determined by using a question naire . Results Infection occurred in 1 of 34 PSC patients ( 2.9 % ) and in 7 of 32 LC patients ( 21.8 % ) , and this difference was statistically significant ( P = 0.021 ) . Patients in the PSC group were more satisfied with the result ing wound scar and its cosmetic appearance at one month and three months after surgery ( P = 0.043 ) . Conclusion After stoma closure , PSC was associated with a significantly lower incidence of wound infection and greater patient satisfaction compared to LC . However , the healing period for patients who underwent PSC was longer than it was for those who underwent LC Background This study aim ed to compare quality of life ( QOL ) , functional outcome , body image , and cosmesis after  h and -assisted laparoscopic ( LRP ) versus open restorative proctocolectomy ( ORP ) .  The potential long-term advantages of LRP over ORP remain to be determined . The most likely advantage of LRP is the superior cosmetic result . It is , however , unclear whether the size and location of incisions affect body image and QOL . Methods In a previously conducted r and omized trial comparing LRP with ORP , 60 patients were prospect ively evaluated . The primary end points were body image and cosmesis . The secondary end points were morbidity , QOL , and functional outcome . A body image question naire was used to evaluate body image and cosmesis . The Short Form-36 Health Survey and the Gastrointestinal Quality of Life Inventory were used to assess QOL . Body image and QOL also were assessed preoperatively . Results A total of 53 patients completed the QOL and functional outcome question naires . There were no differences in functional outcome , morbidity , or QOL between LRP and ORP . At a median of 2.7 years after surgery , 46 patients returned the question naires regarding body image , cosmesis , and morbidity . The body image and cosmesis scores of female patients were significantly higher in the LRP group than in the ORP group ( body image , 17.4 vs 14.9 ; cosmesis , 19.1 vs 13.0 , respectively ) . The female patients in the ORP group had significantly lower body image scores than the male patients ( 14.9 vs 18.3 ) . Conclusions This study is the first to show that ORP has a negative impact on body image and cosmesis as compared with LRP .  Functional outcome , QOL , and morbidity are similar for the two approaches . The advantages of a long-lasting improved body image and cosmesis for this relatively young patient population may compensate for the longer operating times and higher costs , particularly for women Background Ileostomy reversal is associated with surgical site infection ( SSI ) rates as high as 37 % . Recent literature suggests that employing a purse-string approximation ( PSA ) of the reversal wound reduces this rate of SSI . Thus we wished to perform a r and omised controlled trial to compare SSI rates in purse-string versus linear closure ( PLC ) wounds following ileostomy reversal . Methods A r and omised , controlled trial was conducted at University Hospital Limerick . Sixty-one patients undergoing ileostomy reversal were included . Thirty-four patients were r and omised to PSA and 27 patients to linear closure .  The primary endpoint was incidence of SSI and secondary endpoints measured were quality of life and satisfaction with cosmesis . Statistical analysis was performed on a per protocol basis using SPSS version 22.0 . Results Three patients in the PSA group developed an SSI compared to 8 in the PLC group at 30 days ( 8 vs 30 % , p = 0.03 ) . The mean time to SSI diagnosis was faster in the PSA group ( 3 vs 12.3 days , p = 0.08 ) . Patients who developed SSI experienced a longer mean length of stay ( 6.8 vs 11.4 days , p = 0.012 ) . On multivariate analysis , PLC was the only predictive factor of SSI formation ( p < 0.001 ) . There was no difference in patient satisfaction between the two study groups ( p = 0.14 ) . Conclusions PSA of wounds following ileostomy reversal significantly reduces SSI formation compared to linear approximation without any effect on patient satisfaction BACKGROUND : Surgical site infection after stoma reversal is common . The optimal skin closure technique after stoma reversal has been widely debated in the literature . OBJECTIVE : We hypothesized that pursestring near-complete closure of the stoma site would lead to fewer surgical site infections compared with conventional primary closure . DESIGN : This study was a parallel prospect i ve multicenter r and omized controlled trial . SETTING S : This study was conducted at 2 university medical centers . PATIENTS : Patients ( N = 122 ) presenting for elective colostomy or ileostomy reversal were selected . INTERVENTIONS : Pursestring versus conventional primary closure of stoma sites were compared . MAIN OUTCOME MEASURES : Stoma site surgical site infection within 30 days of surgery , overall surgical site infection , delayed healing ( open wound for > 30 days ) , time to wound epithelialization , and patient satisfaction were the primary outcomes measured . RESULTS : The pursestring group had a significantly lower stoma site infection rate ( 2 % vs 15 % , p = 0.01 ) . There was no difference in delayed healing or patient satisfaction between groups . Time to epithelialization was measured in only 51 patients but was significantly longer in the pursestring group ( 34.6 ± 20 days vs 24.1 ± 17 days , p = 0.02 ) . LIMITATIONS : This study was limited by the variability in procedures and surgeons , the limited follow-up after 30 days , and the inability to perform blinding . CONCLUSION : Pursestring closure after stoma reversal has a lower risk of stoma site surgical site infection than conventional primary closure , although wounds may take longer to heal with the use of this approach . Registration number : NCT01713452 ( www . clinical trials.gov ) Surgical site infection ( SSI ) is a common complication following ileostomy closure with a frequency of up to 40 % . This prospect i ve r and omized controlled trial was initiated to compare two surgical techniques – direct suture ( DS ) and purse‐string suture ( PSS ) – used to close the wound following ileostomy closure . The primary end‐point was the SSI rate . Secondary end‐points were cosmetic outcome [ using two vali date d scales : the Patient and Observer Scar Assessment Scale ( POSAS ) and the Body Image Question naire ( BIQ ) ] and the influence of other factors on the SSI rate Ileostomy closure is an operation with an underappreciated morbidity , including surgical‐site infection , small bowel obstruction and anastomotic leakage . Surgical‐site infections , in particular , are a frequent occurrence following closure of contaminated wounds . This r and omized controlled trial compared a purse‐string closure technique with conventional linear closure BACKGROUND : The use of temporary stomas has been demonstrated to reduce septic complications , especially in high-risk anastomosis ; therefore , it is necessary to reduce the number of complications secondary to ostomy takedowns , namely wound infection , anastomotic leaks , and intestinal obstruction . OBJECTIVE : To compare the rates of superficial wound infection and patient satisfaction after pursestring closure of ostomy wound vs conventional linear closure . DESIGN : Patients undergoing colostomy or ileostomy closure between January 2010 and February 2011 were r and omly assigned to linear closure ( n = 30 ) or pursestring closure ( n = 31 ) of their ostomy wound . Wound infection within 30 days of surgery was defined as the presence of purulent discharge , pain , erythema , warmth , or positive culture for bacteria . Patient satisfaction , healing time , difficulty managing the wound , and limitation of activities were analyzed with the Likert question naire . RESULTS : The infection rate for the control group was 36.6 % ( n = 11 ) vs 0 % in the pursestring closure group ( p < 0.0001 ) . Healing time was 5.9 weeks in the linear closure group and 3.8 weeks in the pursestring group ( p = 0.0002 ) . Seventy percent of the patients with pursestring closure were very satisfied in comparison with 20 % in the other group ( p = 0.0001 ) . LIMITATIONS : This study was limited by the heterogeneity in the type of stoma in both groups . CONCLUSION : The pursestring method result ed in the absence of infection after ostomy wound closure ( shorter healing time and improved patient satisfaction ) 
    Output:
    
Discussion QoL was similar in both patients groups after the first postoperative  week .
PSA significantly reduced SSI rate .
No difference was observed in incisional hernia rate , operative time , or length of hospital stay