Having a good understanding of what trusted healthcare evidence is enables us to make more informed healthcare decisions. These four brief videos tailored for patients, caregivers, students, and healthcare professionals, provide a deeper understanding of systematic reviews.

Four brief animations have been co-produced by the Cochrane Crowd team, Evidence Synthesis Ireland, and the public. They are designed for patients, the public, healthcare professionals, students and more, who want to learn about systematic reviews and the main steps involved in producing a review.
They are free to use for teaching public and patient involvement - just give credit and let us know you are using them.

"At Cochrane patient and carer engagement and involvement plays a vital role," says Anna Noel-Storr, Cochrane’s Evidence Pipeline Lead. “We’ve created four 2-minute animations covering the key steps involved in producing a systematic review. Systematic reviews are such an important part of what we do. They help us to assess the effectiveness of treatments.These animations are designed to give a glimpse into what’s involved in producing a systematic review. We hope you’ll enjoy them!"

Asking the right questions

Finding the evidence

Assessing the evidence



Synthesizing the evidence

Interested in learning more? Explore Cochrane Evidence Essentials, a comprehensive introduction to Evidence-Based Medicine, clinical trials, and Cochrane evidence. Gain essential insights to navigate the complexities of healthcare research and make informed decisions with confidence.

Cochrane's members and supporters come from more than 130 countries, worldwide. Our volunteers and contributors are researchers, health professionals, patients, carers, people passionate about improving health outcomes for everyone, everywhere.

Getting involved in Cochrane’s work means becoming part of a global community. The Cochrane International Mobility programme connects successful applicants with a placement in a host Cochrane Group, where they learn about the production, use, and knowledge translation of Cochrane reviews. The prgramme offers opportunities for learning and training not only for participants but also for host staff.

In this series, we profile those who have participated in the Cochrane International Mobility Program and learn more about their experiences.

Name: Yu-Tian
Location: China
CIM Location: Cochrane Sweden

How did you first learn about Cochrane?
I first learned about Cochrane in 2015 when I was a medical student at Fudan University in Shanghai, China. I was browsing through an online Chinese discussion forum for medical professionals and I came across a post giving a brief introduction to Cochrane. This aroused my interest and I further explored the official website of Cochrane. Before long I started participating in RCT screening in Cochrane Crowd and applying for tasks on the volunteer platform Cochrane Engage. In 2016, I decided to attend the 24th Cochrane Colloquium in Seoul, where I met many encouraging people in person who provided help and detailed guidance on how to get started. Most notably, I was fortunate to meet Juan Franco and colleagues, who invited me to become a co-author of two Cochrane reviews on non-pharmacological and pharmacological interventions for treating chronic prostatitis/chronic pelvic pain syndrome.

What was your experience with your Cochrane International Mobility?
I had previously completed a few requests on Cochrane Engage posted by Matteo Bruschettini from Cochrane Sweden, and in 2023 he involved me in a Cochrane review update. Matteo is super kind, supportive, and professional in both neonatal care and evidence synthesis methodology. Our team of three held Zoom meetings on a regular basis, where Matteo would always patiently guide us through every single step and explain to us in details from the evolution of Cochrane methods to tips on software use.

What are you doing now in relation to your virtual Cochrane International Mobility experience?
We have just submitted our Cochrane review about cycled light in NICU for preterm and low birth weight infants. I didn't even realize how much I had learned from this experience until now, as I work on other systematic reviews related to urology; I feel much more confident and everything runs much more smoothly than I previously expected. I am truly grateful to Matteo for providing this wonderful virtual CIM experience.

Do you have any words of advice to anyone considering a Cochrane International Mobility experience?
I strongly encourage anyone interested in systematic review and critical appraisal of evidence to participate in Cochrane activities and connect to the welcoming culture and people. For those who are getting started, remember that Cochrane Handbook and the abundant resources in Cochrane Training are always there for you, and that a CIM experience is the best opportunity to find you a teacher and put everything you are learning into practice. Do not give up or feel frustrated that you are not making any real progress; all these bits of training will gradually sink in, and one day they’ll just click.

Lund University in Sweden is using Cochrane training materials and tools to help medical students better understand and interpret health evidence.

Lund has an institutional subscription offering all staff and students access to Cochrane Interactive Learning and RevMan. Cochrane Interactive Learning was developed by world-leading experts and provides 12 modules of self-directed learning on conducting a complete systematic review process for both new and experienced review authors. RevMan simplifies creating systematic reviews and meta-analyses and presenting the results in forest plots. Lund has successfully embedded these resources into their medical education curriculum since 2018. 

In 2017, the university’s medical degree program team reviewed their curriculum with a view to enhancing the scientific scholarship elements of the course. Working closely with Cochrane Sweden and the faculty library, they developed a curriculum that embeds Cochrane Interactive Learning modules and practical tools to help future doctors better engage with and contribute to scientific literature. 

The initiative was spearheaded by Maria Björklund, Librarian in Lund University’s Faculty of Medicine, who collaborated with colleagues across the university to make the Cochrane-informed curriculum a reality. The team have now described and published their approach in BMJ Evidence Based Medicine to help other medical schools who may wish to follow suit. 

“Incorporating Cochrane training materials in the curriculum has proven to be a success,” says Maria. “Student feedback has been positive, and some have been inspired to co-author their own systematic reviews or go into clinical research. It’s been a collaborative effort from the start and has been incredibly rewarding for everyone involved. The Cochrane modules perfectly complement our refreshed curriculum, supported by passionate tutors and doctors practicing evidence-based medicine sharing their real-world experience of how to apply the principles in practice.” 

The curriculum embeds Cochrane Interactive Learning, which offers online interactive courses to any university or individual with a subscription. These provide a thorough grounding in systematic review and evidence evaluation, supported by in-person workshops and assignments throughout the Lund University course. 

The close collaboration between faculty staff at Lund and Cochrane Sweden means that students who are inspired to take their interest further have excellent opportunities to do so. Matteo Bruschettini, Director of Cochrane Sweden, helps to mentor and support students who want to co-author their own Cochrane reviews in their areas of interest. 

“Thanks to the Cochrane training materials in the curriculum, many students are inspired and empowered to conduct systematic reviews,” says Matteo. “Through Cochrane Sweden, we help them to design and take forward new Cochrane reviews. This is really a win-win, as we know that the students have an excellent grounding in the relevant methods and we can help them put it into practice and contribute to health evidence themselves. Collaboration is key to the success of this project, and Lund is very lucky to have Maria and her team to drive this forward.” 

Cochrane resources are currently embedded in Lund’s medical doctor training course, and are being rolled out in other subjects including public health, psychology and medical science. This has been driven by word of mouth due to the popularity of the modules among staff and students.

“It’s inspiring to see how Lund University has used Cochrane resources to enhance their medical training and ensure that the doctors of the future are well-equipped to navigate the complex evidence landscape,” says Catherine Spencer, Chief Executive of Cochrane. “I would love to see more medical schools around the world following their example, and we would be happy to speak to anyone who is interested in taking this forward." 

• Learn more about Cochrane Interactive Learning|
• Learn more about RevMan

At the Cochrane Collaboration, open science has long been at the heart of our ethos. From publishing free plain language summaries in multiple languages to making study data available, we have always strived to make our evidence accessible, transparent and useful to as many people as possible.

Since 2013, we’ve made all Cochrane reviews freely available 12 months after publication and all protocols freely available immediately. Over 3 billion people worldwide have immediate access to all content through national access agreements and our free access offering to over 100 low- and middle-income countries.

We’d like to go further to ensure that everyone can benefit from access to Cochrane evidence. However, in this challenging funding environment, we still need income to keep producing and publishing the reviews that are trusted by researchers, clinicians and policymakers worldwide.

We have to balance our open access ambitions with our responsibility to run the charity sustainably. A model that made our content free, but deprived us of the income to produce or publish it in the first place, would be of little benefit to anyone. Our original ambition was to make all Cochrane reviews open by 2025 if we could identify a financially sustainable path to get there, without putting the onus on authors. However, it became clear that this would not be possible in that timescale. While full open access remains our ambition, we have to be realistic about how long this will take and are exploring ways to broaden access to our content in the meantime.

Our independence is one of our core founding principles; we do not accept donations or sponsorship from conflicted sources, such as pharmaceutical or medical device companies. That makes us unusual among medical and scientific charities, many of which rely on corporate benefactors to pay the bills. Not Cochrane. As a charity that publishes impartial assessments of many medical interventions and diagnostics produced and promoted by corporations, we have a strong conflict of interest policy to protect our content from undue influence.

We want our reviews to be accessible to as many people as possible, but we won’t compromise our principles or quality. The complexity of producing, editing and publishing systematic reviews makes Cochrane a poor fit for the current ‘gold’ open access model, where authors pay a fee to cover publishing costs. Conducting and publishing systematic reviews is neither cheap nor easy, and this vital work needs to be funded.

As we can’t make everything open access immediately, we are working with our publisher, Wiley, to broaden global access to Cochrane content while ensuring we can still produce it.

We are working together to significantly expand free public access worldwide. Fourteen countries currently have national provisions whereby government agencies sponsor free public access for everyone in the country. Visitors from those countries do not encounter paywalls and can access Cochrane Library content without logging in. Building on this, we aim to unlock content for large regions when a critical mass of countries within the region subscribe to the Cochrane Library via national provisions. We will work towards this goal collaboratively with Cochrane groups across the world, national funding agencies and Wiley.

We intend to make all review protocols open access from 2025 onwards with a CC-BY license and are exploring open access for other outputs such as editorials and plain language summaries. We will continue to invest in our open access journal, Cochrane Evidence Synthesis and Methods, helping the global evidence synthesis community to keep up with the latest methodological developments. We may also add other open access journals to our core database of products in the future.

We are still working out the details of our long-term transition to open access, but we are confident that we will arrive at a sustainable solution that balances the needs of authors, readers and subscribers. The Cochrane Collaboration was founded 30 years ago to fill a crucial evidence gap, and we need to preserve our income and integrity to ensure we can continue to fulfil our mission in the decades to come. We hope that you will support us on this journey as we strive to produce the best health evidence and make it accessible to everyone, everywhere.

New online learning is now freely available about critical appraisal of rapid reviews as part of Cochrane’s flagship Evidence Essentials modules for the public.

Written from the perspective of a healthcare consumer this new module is for anyone interested in the critical appraisal of rapid systematic reviews or any review.

By the end of this module, you should be able to:

• Outline when and why a rapid review may be conducted
• Describe the differences between rapid and systematic reviews
• Understand and apply key concepts for assessing the quality of a rapid review by using the CASP tool

The learning is interactive, with quizzes, animations, and ways to check your knowledge.

This module is the latest in Cochrane’s “Evidence Essentials” that gives an introduction to Evidence Based Medicine, clinical trials, systematic reviews and how to use evidence when making decisions about your health. The modules have been visited over 97,000 times since their launch, and the first 4 modules have now been translated into Spanish, German, and Russian.

The module’s content creation has been led by Emily Clark, National Collaborating Centre for Methods and Tools at the McMaster University, School of Nursing. Emily welcomed the launch of the new module:

“I’m so excited to see the launch of the module. It builds on the work that we have been doing at McMaster to spread understanding of critical appraisal of rapid reviews amongst the wider public. We’ve used a rapid review about risk factors associated with severe COVID-19 outcomes in children 5 years and under as the basis for this learning, and we show people how to use the CASP framework to appraise a review. This new Evidence Essential model should give non-scientists a way to check the quality of a review.”

Richard Morley, Cochrane’s Consumer Engagement Officer, said:

“The Evidence Essentials puts into one exciting place information that consumers (patients, carers and the public) can use to understand about health research, and in the case of this latest module, assess the quality of a review before using it to make decisions about healthcare choices. In a world where information and misinformation are abundant, the ability to judge the evidence is vital for the public.”

There are now six interactive modules in Evidence Essentials: an introduction to Evidence-Based Medicine, Randomized Controlled Trials, Introduction to systematic reviews, Understanding and using systematic reviews; Consumer involvement in Cochrane and the latest, Critical appraisal of rapid reviews.

Modules are free to use, with a Cochrane account and are found at https://training.cochrane.org/essentials

A new Cochrane review has found that taking zinc may help to reduce the duration of common cold symptoms by about two days, but the evidence is not conclusive and potential benefits must be balanced against side-effects. 

Since the 1980s, zinc products have been marketed as treatments for the common cold and are particularly popular in the USA. Zinc is an essential mineral naturally found in many foods and plays a role in immune function. Most people in high-income countries get enough zinc through their diets, although aging and some chronic diseases may lead to deficiency. 

The theory behind zinc-based lozenges, sprays and syrups is that the zinc may interfere with viral replication when it comes into contact with viral particles in the nose, mouth and throat. Zinc has been shown to interfere with viral replication in petri dishes and mice, although this alone doesn't tell us whether something will work in real people. 

To test if zinc is useful in preventing or treating a cold, a team of researchers looked at 19 human trials examining zinc as a treatment and 15 as a preventative measure. They identified a lot of variation between the studies in how zinc was administered, how much was given, how they defined a ‘cold’ and what they measured. 

Eight studies with 972 participants investigated zinc as a treatment to reduce cold duration. Combining the results of these studies yielded low-certainty evidence that it may help to reduce duration by around two days, down from an average week-long duration in the groups who received placebo.  

The review found no strong evidence to conclude that zinc treatment impacts the severity of cold symptoms. The prevention studies showed no clear evidence of benefit from taking zinc before the onset of a cold; those taking zinc preventatively had similar outcomes to those who didn’t. 

Common side-effects of zinc reported in the trials included bowel problems, nausea and unpleasant taste. There was no clear evidence of more serious side-effects directly resultant from zinc. 

“People considering zinc to treat a cold should be aware of the limited evidence base and possible side-effects,” says Assistant Professor Daryl Nault of Maryland University of Integrative Health, first author of the review. “Ultimately, it’s up to the individual to decide whether the risk of potential unpleasant side-effects is worth the benefit of potentially shortening their illness by a few days. The best advice remains to consult your physician if you’re feeling unwell and inform them if you use any supplements. While there have been many trials investigating zinc, the approaches vary, so it is difficult to draw conclusions with certainty.” 

The trials included in the review varied in many ways including the type of zinc, the dose of zinc given, whether it was given as a lozenge or nasal spray, and how the outcomes were reported and measured. Some trials measured for a fixed time window and asked participants if they still had a cold at the end. Others measured the time between symptoms starting and resolving, although this was defined slightly differently by each study. Few studies monitored the status of individual symptoms, such as sore throat, cough or fever, so there was insufficient evidence to draw any reliable conclusions about specific symptoms. 

“The evidence on zinc is far from settled: we need more research before we can be confident in its effects,” says Assistant Professor Susan Wieland of the University of Maryland School of Medicine, senior author of the review. “Future studies should adopt standardized methods for administering and reporting treatments and defining and reporting outcomes. Additional studies focusing on the most promising types and doses of zinc products and using appropriate statistical methods to assess outcomes that are important to patients will enable us to understand whether zinc may have a place in treatment of the common cold.” 

• Read the full Cochrane review and plain language summary in the Cochrane Library 
• Listen to the podcast

Specifications: Permanent – Full Time (1.0 FTE.)
Salary:   circa £35,000 per Annum
Location: (Remote – Flexible) Ideally based in the UK, Germany or Denmark. Candidates anywhere from the world will be considered; however, Cochrane’s Central Executive Team is only able to offer consultancy contracts outside these countries for 1-Year.
Closing date: 21 April 2024

Cochrane is an international charity. For 30 years we have responded to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesising research findings and our work has been recognised as the international gold standard for high quality, trusted information.

Cochrane's strength is in its collaborative, global community. We have 110,000+ members and supporters around the world. Though we are spread out across the globe, our shared passion for health evidence unites us. Our Central Executive Team supports this work and is divided into four directorates: Evidence Production and Methods, Publishing and Technology, Development, and Finance and Corporate Services.

To help maintain and evolve Cochrane’s cloud hosting and application deployment infrastructure, ensure applications’ dependencies are kept current (both independently and in collaboration with development teams), and promote operational awareness across the infrastructure. This role works across development and operations (DevOps).

Don’t have every single qualification? We know that some people are less likely to apply for a job unless they are a perfect match. At Cochrane, we’re not looking for “perfect matches.” We’re looking to welcome people to our diverse, inclusive, and passionate workplace. So, if you’re excited about this role but don’t have every single qualification, we encourage you to apply anyway. Whether it’s this role or another one, you may be just the right candidate.

Our organization is built on four core values: Collaboration: Underpins everything we do, locally and globally. Relevant: The right evidence at the right time in the right format. Integrity: Independent and transparent. Quality: Reviewing and improving what we do, maintaining rigour and trust.

You can expect:

• An opportunity to truly impact health globally.
• A flexible work environment
• A comprehensive onboarding experiences.
• An environment where people feel welcome, heard, and included, regardless of their differences.

Cochrane welcomes applications from a wide range of perspectives, experiences, locations, and backgrounds; diversity, equity and inclusion are key to our values.

How to apply

• For further information on the role and how to apply
• The deadline to receive your application is 21 April 2024.
• The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples.
• Read our Recruitment Privacy Statement

We are thrilled to announce the publication of a new editorial titled "Unlocking the Power of Global Collaboration: Building a Stronger Evidence Ecosystem Together," authored by Prof Zoe Jordan of JBI, Dr Vivian Welch of The Campbell Collaboration, and Dr Karla Soares-Weiser of Cochrane. This editorial is now available simultaneously in JBI Evidence Synthesis, Campbell Systematic Reviews, and the Cochrane Database of Systematic Reviews. It underscores the urgent need for collaborative efforts to harness the potential of evidence synthesis on a global scale. This collaborative endeavour reflects the shared commitment of the three organisations to foster cooperation, aiming to enhance both health outcomes and policy efficacy worldwide.

The editorial highlights the pivotal role of collaboration in addressing contemporary global challenges, emphasizing the collective commitment of JBI, The Campbell Collaboration, and Cochrane to foster cooperation for enhanced health outcomes and policy efficacy worldwide. Dr. Karla Soares-Weiser said: "This co-publication marks a significant milestone for all three of our organizations and reaffirms our dedication to collaboration. Our respective communities are profoundly collaborative and communicative within their domains, and we'd now like to catalyze further collaboration between and across them. We're particularly excited about the upcoming Global Evidence Summit, where leaders in evidence synthesis and evidence-based practice, including Cochrane, JBI, Guidelines International Network (GIN), and The Campbell Collaboration, will convene to share best practice and promote cross-disciplinary working."

Scheduled for September 2024, the Global Evidence Summit represents a unique opportunity for professionals across various sectors to engage in discussions about evidence production, summarization, and dissemination, informing policy and practice. Dr. Soares-Weiser emphasized the importance of this event: "The GES serves as a platform for knowledge exchange and collaboration, crucial for addressing global challenges in health, education, social justice, and the environment." As the editorial advocates for a shift towards enhanced collaboration, the Global Evidence Summit sets the stage for meaningful dialogue and action.

• Learn more about the Global Evidence Summit
• Read the editorial

Jordan Z, Welch V, Soares-Weiser K. Unlocking the power of global collaboration: building a stronger evidence ecosystem together. Cochrane Database of Systematic Reviews 2024, Issue 4. Art. No.: ED000166. DOI: 10.1002/14651858.ED000166.

Door-to-door tuberculosis (TB) screening and contact tracing can improve diagnosis rates, but must be paired with effective follow-up care to be successful, a new Cochrane review has found.

Active case finding (ACF) seeks to improve diagnosis rates in people living in communities who may not otherwise present to health facilities, helping them access treatment and reduce onward transmission.

Despite being a key strategy of most TB strategies globally, there is often little consideration of how these programmes are experienced by communities. This is essential in designing appropriate and effective services.

Published ahead of World TB Day (24 March), a new review published by Cochrane Infectious Diseases, based at Liverpool School of Tropical Medicine, looked at studies of community experiences towards ACF programmes for TB in any endemic low- or middle-income country. This was a qualitative evidence synthesis that looked at the evidence from 45 studies. 

Senior author and Cochrane Infectious Diseases Editor, Professor Sandy Oliver,  said, “The power of qualitative syntheses like these is in their ability to capture rich information from various contexts to develop a deep understanding of how policies play out in the real world – how services deliver them, how communities receive them or avoid them, what might make them work a little better, and why”.

The review authors found that ACF improves access to diagnosis for many, but does little for those in financial need to continue care. People may also experience stigma in relation to screening.

It was also shown that ACF can create expectations for follow-up care that health systems may not be able to meet, as well as health workers finding it difficult to implement.

This Cochrane Review will help to better understand policy in action and the perceived benefit relative to the harm of ACF.

Lead author Melissa Taylor said: “Active case finding brings diagnosis to many of those who may otherwise not have received it. However, our review demonstrates it is essential that active case finding is linked to well-resourced follow up services and wider health system strengthening.”

• Read the full Cochrane review and plain language summary
• Learn more about this review on the Cochrane Infectious Diseases website

Taylor M, Medley N, van Wyk SS, Oliver S. Community views on active case finding for tuberculosis in low‐ and middle‐income countries: a qualitative evidence synthesis. Cochrane Database of Systematic Reviews 2024, Issue 3. Art. No.: CD014756. DOI: 10.1002/14651858.CD014756.pub2

In this blog for colorectal surgeons and health professionals involved in stoma reversals, Dr Stina Öberg, Dr Siv Fonnes, and Professor Jacob Rosenberg from the Cochrane Colorectal Group discuss new practice-changing Cochrane evidence, showing that a simple change of suture technique likely results in a large reduction in surgical site infections in people undergoing stoma reversal.

Take-home points

• The stoma closure site can be considered a clean-contaminated wound, and many patients develop a surgical site infection after having a temporary ileostomy or colostomy reversed.
• Surgeons often use linear skin closure after stoma reversal. In theory, a clean-contaminated wound can benefit from drainage, which is achieved by using the purse-string skin closure technique.
• A new Cochrane Review has demonstrated that the purse-string skin closure technique likely results in a large reduction in surgical site infections after stoma reversal compared with linear skin closure.
• This simple and inexpensive change of practice may also improve patient satisfaction slightly. Even though the evidence is very uncertain, there seems to be no difference in incisional hernias.

Can surgeons improve their skin closure technique after stoma reversal? Yes - in a straightforward way! Researchers have found clinically important evidence in a new Cochrane review, showing that a simple change of suture technique likely results in a large reduction of surgical site infections in people undergoing stoma reversal. This blog presents the key results from this Cochrane review.

Skin closure after stoma reversal
Temporary stomas are created to protect distal bowel segments. At the time of stoma reversal, the last step is to close the skin. Due to the proximity to intestinal content, the stoma closure site should be considered a clean-contaminated wound. This could also explain why surgical site infections are common after stoma reversal, occurring in up to 40% of patients. When a wound is potentially contaminated, it will in theory benefit from free drainage.

Linear skin closure
Most surgeons use linear (transverse) skin closure despite the possible contamination of the wound at the stoma reversal site. Linear skin closure provides poor or no wound drainage and is theoretically a poor choice for a clean-contaminated wound. The stoma reversal wound is often close to a circular shape, and there is an alternative skin closure technique that at the same time provides drainage - the purse-string technique.

Purse-string skin closure
The purse-string skin closure technique can be used for circular or ellipse-formed wounds. The technique is performed by using intradermal sutures that are drawn together like an old-fashioned drawstring purse (see illustration at the top of the page), leaving a small opening in the centre. The theoretical advantage of using purse-string skin closure for a clean-contaminated wound is that it provides free drainage. This advantage could lower the risk of developing surgical site infections compared with linear skin closure. A lower surgical site infection risk could also result in a better cosmetic result, a higher patient satisfaction, and fewer incisional hernias.

What are the benefits of the purse-string skin closure?
In the Cochrane review comparing purse-string skin closure versus linear skin closure in people undergoing stoma reversal, surgical site infection was assessed in nine randomised controlled trials including almost 800 patients. The purse-string technique likely results in a large reduction in surgical site infections compared with linear skin closure. The anticipated risk within 30 days after linear closure was 243 surgical site infections per 1000 patients versus 52 (95% confidence interval 28 to 85) per 1000 patients after purse-string skin closure.

Purse-string closure may also have other advantages over linear closure. Patients who received the purse-string skin closure seemed to be slightly more satisfied six and twelve months after surgery: the anticipated effect in two randomised controlled trials was 885 satisfied or very satisfied patients per 1000 patients having linear skin closure versus 994 (95% confidence interval 894 to 1000) per 1000 patients having purse-string skin closure.

Finally, a reduced risk of surgical site infections could reduce the risk of incisional hernias. This outcome was reported by four randomised controlled trials with nearly 300 patients followed between three and twelve months, showing an anticipated risk of 55 incisional hernias per 1000 patients after linear skin closure versus 29 (95% confidence interval 4 to 177) per 1000 patients having purse-string skin closure. Even though the purse-string skin closure theoretically could lower the risk of incisional hernias, this was not shown, and there seems to be little to no difference in the risk of developing incisional hernias regardless of the skin closure technique used. However, the evidence is very uncertain, and further randomised controlled trials with longer follow-up might alter this result.

What are the benefits of linear skin closure?
The Cochrane review showed no advantage of using linear skin closure compared with purse-string skin closure in patients undergoing stoma reversal.

What are the risks of the purse-string skin closure?
The Cochrane review suggested that there was no evidence of an increased risk when patients received the purse-string technique compared with linear skin closure.

Pros and cons of purse-string versus linear skin closure
To summarise:

The benefits of using purse-string skin closure:

• likely results in a large reduction in surgical site infections
• may improve patient satisfaction slightly

The benefits of using linear skin closure:

• none found

There seems to be no evidence of a difference between purse-string and linear skin closure regarding:

• incisional hernia (but the evidence is very uncertain)
• operative time (but the evidence is very uncertain)
• length of hospital stay (but the certainty of evidence is unknown)
• anastomotic leak (but the certainty of evidence is unknown)
• intestinal obstruction (but the certainty of evidence is unknown)

Which skin closure technique is best to use after stoma reversal?
Purse-string skin closure both has the theory and the evidence to back up a lower risk of surgical site infections compared with linear skin closure, seemingly without any risks of complications. The result from this Cochrane review could make surgeons reconsider their skin closure method in patients undergoing stoma reversal. A change of practice from linear to purse-string skin closure is both straightforward and inexpensive.

Clinical reflections on the implications of the review
When asking Professor Jacob Rosenberg, the co-ordinating editor of the Cochrane Colorectal Group, about the clinical implications of this Cochrane Review, he stated that:

• This review clearly shows that a simple change in skin closure technique can have a large impact on patient outcome after stoma reversal.
• The purse-string skin closure technique for the stoma site is simple, effective, and seemingly without negative effects.
• These results have the potential to change clinical practice around the world.
• The recommendation to use the purse-string method for skin closure of stoma sites should be included in future clinical guidelines.

Read the full Cochrane Review and plain language summary in the Cochrane Library 

Listen to the lead author, Shahab Hajibandeh from Health Education and Improvement Wales, to tell us more about this review in three minutes

Hajibandeh S, Hajibandeh S, Maw A. Purse‐string skin closure versus linear skin closure in people undergoing stoma reversal. Cochrane Database of Systematic Reviews 2024, Issue 3. Art. No.: CD014763. DOI: 10.1002/14651858.CD014763.pub2. 

Image: The featured image at the top of the page was created by Malene Agnete Højland and Louise Rosengaard from the Cochrane Colorectal Group.