Gunsight closure versus conventional techniques for reversal of protective stoma after rectal cancer surgery - a propensity score matching study

Q: What is the main purpose of this study?

To compare the clinical and patient-reported outcomes of gunsight closure versus conventional linear closure for protective stoma reversal after rectal cancer surgery.

Q: How was the study performed?

A retrospective propensity score matching analysis was conducted on 194 patients who underwent stoma reversal between 2016 and 2023, followed by comparisons of outcomes and a PROM-based questionnaire at 6 months.

Q: What were the key results after matching?

The gunsight group had significantly lower SSI rates and lower early postoperative pain scores (POD 1 and POD 2), while operative time and overall complication rates showed no significant differences; pain-relief satisfaction was higher.

Sep 29, 2026

Uploaded by Genevieve

Retrospective propensity score matching compared the gunsight closure technique with conventional linear closure for reversal of protective stoma in rectal cancer surgery, focusing on surgical-site infection (SSI), wound complications, early pain, and patient-reported outcomes. Analysis included 194 patients treated between 2016 and 2023, with a PROM-based self-designed questionnaire administered at 6 months. After matching, the gunsight group showed lower SSI and reduced early postoperative pain, with improved pain-relief satisfaction without increased complications.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Background

Clinical rationale for stoma and SSI risk

Prior closure techniques and rationale

International Journal of Colorectal Disease (2026) 41:15 [https://doi.org/10.1007/s00384-025-05062-x](https://doi.org/10.1007/s00384-025-05062-x) Gunsight closure versus conventional techniques for reversal of protective stoma after rectal cancer surgery: a propensity score matching study Senbin Lin1 · Misha Mao2 · Rui Chen1 · Linnan Guo1 · Mengya Zhou1,3 · Jianhui Chen1 Received: 1 July 2025 / Accepted: 10 December 2025 © The Author(s) 2026 Abstract Background Surgical site infection (SSI), wound-related complications, and incisional hernia are common concerns following stoma reversal. These complications can significantly impair postoperative recovery and quality of life, especially in rectal cancer patients. This study compared the clinical and patient-reported outcomes of two protective stoma reversal procedures, the gunsight and conventional linear closure techniques. Methods A retrospective propensity score matching (PSM) analysis was conducted on 194 patients who underwent stoma reversal between 2016 and 2023. Baseline characteristics, surgical outcomes, postoperative complications, and patient satisfaction were compared between the gunsight and conventional closure groups. A structured, self-designed questionnaire based on the principles of patient-reported outcome measures (PROMs) was administered at 6 months post-operatively to assess pain relief, wound healing, scar appearance, and functional recovery. Results After PSM, 97 matched pairs were analyzed. The gunsight group had significantly lower SSI rates (11.34% vs. 22.68%, p = 0.036) and reported lower postoperative pain scores on POD 1 (p< 0.001) and POD 2 (p = 0.003) . No significant differences were observed in terms of operative time, hospital stay, wound dehiscence, or incidence of incisional hernia. Patient-reported satisfaction with pain relief was significantly greater in the gunsight group (p = 0.012), whereas overall satisfaction scores were comparable. Conclusion The gunsight closure technique reduces postoperative infections and early postoperative pain without increasing complication rates. It also improves early patient-reported outcomes, making it a safe, effective, and patient-centered alternative for stoma reversal in rectal cancer surgery. Keywords Reversal of protective stoma · Surgical site infections · Rectal cancer · Patient-reported outcome measures · Incisional hernia | Senbin Lin and Misha Mao contributed equally to this work. | | --- | | Highlights
• Compared with conventional linear closure, the gunsight closure technique significantly decreases surgical site infection rates after stoma reversal.
• Patients who undergo gunsight closure have less postoperative pain, particularly in the early recovery phase.
• Gunsight closure provides a safer, more comfortable postoperative course and is a promising alternative for clinical practice. | Extended author information available on the last page of the article Background Colorectal cancer is the third most commonly diagnosed malignancy worldwide, with a steadily increasing incidence in recent years [1] . For high-risk rectal cancer patients who undergo sphincter-preserving surgery, a temporary diverting ileostomy is routinely constructed in clinical practice [2] . Although the effectiveness of ileostomy in preventing anastomotic leakage remains controversial [3], it can effectively mitigate the clinical consequences of leakage, limit the spread of infection, and promote patient recovery [4] . Stoma reversal is typically performed approximately three months after the initial surgery. However, stoma reversal is associated with a high risk of surgical site infection (SSI) at the stoma site, primarily because of intraoperative bowel opening and contamination of the peristomal skin, which is often inflamed [5] . The conventional linear closure technique involves symmetrical approximation of the skin edges but is associated with increased wound tension, slowe

FAQs

What is the main purpose of this study?

To compare the clinical and patient-reported outcomes of gunsight closure versus conventional linear closure for protective stoma reversal after rectal cancer surgery.

How was the study performed?

A retrospective propensity score matching analysis was conducted on 194 patients who underwent stoma reversal between 2016 and 2023, followed by comparisons of outcomes and a PROM-based questionnaire at 6 months.

What were the key results after matching?

The gunsight group had significantly lower SSI rates and lower early postoperative pain scores (POD 1 and POD 2), while operative time and overall complication rates showed no significant differences; pain-relief satisfaction was higher.

Sep 29, 2026

Uploaded by Genevieve