Purpose: Stoma reversal is associated with notable postoperative morbidity. Several techniques exist for skin closure after stoma reversal, with linear primary closure (LC) and purse-string closure (PS) being the most common. This systematic review and meta-analysis aim to compare LC and PS skin closure after stoma reversal in terms of surgical site infection (SSI) rates, wound healing, and cosmesis. Methods: In accordance with the PRISMA statement, a systematic review of skin closure after stoma reversal was conducted using MEDLINE (PubMed), Embase, Web of Science, and Scopus. Results: Eleven studies, enrolling 1,052 patients (PS, n=534; LC, n=518), published between 2006 and 2024, were included. The overall quality of the studies was considered acceptable, with a mean Jadad scale score of 4 (range, 3–5). Patients underwent ileostomy or ileostomy/colostomy in 6 and 5 studies, respectively. No differences were observed between groups in operative time, length of hospital stay, intestinal obstruction, or incisional hernia. However, SSI and overall infection rates were higher in the LC group, with a statistically significant difference for SSI. Conclusion Skin closure following stoma reversal using the PS technique may offer advantages over LC. PS is associated with significantly lower SSI rates compared to LC. Although a large randomized controlled trial with long-term follow-up is still required, current findings suggest that PS could be considered the standard of care for wound closure after ileostomy reversal.

This study aims to discuss the principles and pillars of robotic colorectal surgery training and share the training pathway at Portsmouth Hospitals University NHS Trust. A narrative review is presented to discuss all the relevant and critical steps in robotic surgical training. Robotic training requires a stepwise approach, including theoretical knowledge, case observation, simulation, dry lab, wet lab, tutored programs, proctoring (in person or telementoring), procedure-specific training, and follow-up. Portsmouth Colorectal has an established robotic training model with a safe stepwise approach that has been demonstrated through perioperative and oncological results. Robotic surgery training should enable a trainee to use the robotic platform safely and effectively, minimize errors, and enhance performance with improved outcomes. Portsmouth Colorectal has provided such a stepwise training program since 2015 and continues to promote and augment safe robotic training in its field. Safe and efficient training programs are essential to upholding the optimal standard of care.