Conservative Treatment Versus Elective Repair of Umbilical Hernia in Patients With Ascites and Liver Cirrhosis (CRUCIAL)
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Purpose
The purpose of the present study is to investigate whether or not to perform elective surgical repair of umbilical hernias in patients with liver cirrhosis and ascites. There are no other randomized controlled trials in this area. The optimal management in patients with umbilical hernias and liver cirrhosis with ascites is not clear yet. The general surgical opinion is that umbilical hernias in patients with ascites should not be corrected because of the supposedly high operative risks and high recurrence rates. Conservative treatment, however, can have severe complications resulting in emergency repair. Such operations carry a higher risk of complications than elective operations, particularly in this group of patients. Prospective and retrospective series showed us that elective hernia repair in this specific patient group is safe without major complications or high recurrence rates.
The aim of this study is to asses the optimal timing of correction of umbilical hernia in patients with liver cirrhosis and ascites.
| Condition | Intervention | Phase |
|---|---|---|
|
Umbilical Hernia Liver Cirrhosis Ascites |
Procedure: Conservative treatment Procedure: Surgical repair |
Phase 3 |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Safety/Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | Conservative Treatment Versus Elective Repair of the Umbilical Hernia in Patients With Ascites and Liver Cirrhosis, a Randomized Controlled Trial |
- complications [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]The primary endpoint in this study is a composite endpoint of the overall morbidity after 24 months, which includes; Reoperation for complication (e.g. hemorrhage; Decompensated liver failure(e.g. Portal vein thrombosis; Non-closure of surgical wound at 4 weeks; Haematoma; Seroma; Rupture of hernia; Bowel incarceration; Necrosis and rupture of the overlying skin; Evisceration; Pneumonia; Urinal tract infection; Postoperative surgical site infection (superficial/deep/organ space); Postoperative leakage of ascites more than 2 weeks after surgery
- Recurrence [ Time Frame: 2 years ] [ Designated as safety issue: No ]
- Mortality [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]
- Length of hospital stay [ Time Frame: 3 months ] [ Designated as safety issue: No ]
- Quality of life [ Time Frame: 2 years ] [ Designated as safety issue: No ]
- Cost effectiveness [ Time Frame: 2 years ] [ Designated as safety issue: No ]
| Estimated Enrollment: | 100 |
| Study Start Date: | January 2011 |
| Estimated Study Completion Date: | December 2015 |
| Estimated Primary Completion Date: | December 2013 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Active Comparator: Conservative treatment
Patients that randomize for conservative management of their umbilical hernia will be followed routinely at the polyclinical ward.
|
Procedure: Conservative treatment
Patients that randomize for conservative management of their umbilical hernia will be followed routinely at the polyclinical ward.
|
|
Active Comparator: Surgical repair
Patients that randomize for surgical repair of their umbilical hernia will be operated in an elective setting after a careful preoperative work-up.
|
Procedure: Surgical repair
Patients that randomize for surgical repair of their umbilical hernia will be operated in an elective setting after a careful preoperative work-up.
|
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Primary Umbilical hernia
- Liver cirrhosis
- Ascites (US proven)
- Age ≥ 18 years
- Signed Informed consent
Exclusion Criteria:
- Recurrent umbilical hernia
- Midline laparotomy in medical history
- ASA1 score IV or above
- Incarcerated hernia related emergency procedures
- Patent umbilical vein; >5mm
- Expected time to Ltx <3 months
Contacts and Locations| Contact: B. de Goede, Msc | +31 6280661102 | b.degoede@erasmusmc.nl |
| Contact: H.H. Eker, MD | +31 628925554 | h.eker@erasmusmc.nl |
| Netherlands | |
| Erasmus Medical Center | Recruiting |
| Rotterdam, Zuid-Holland, Netherlands, 3015CE | |
| Contact: B. de Goede, Msc | |
| Contact: H.H. Eker, MD | |
| Principal Investigator: G. Kazemier, MD, PhD | |
| Principal Investigator: | G Kazemier, MD, PhD | Erasmus Medical Center |
| Principal Investigator: | J.F. Lange, MD, PhD | Erasmus Medical Center |
More Information
No publications provided
| Responsible Party: | hasan eker, Dr. G. Kazemier, Erasmus Medical Center |
| ClinicalTrials.gov Identifier: | NCT01421550 History of Changes |
| Other Study ID Numbers: | CRUCIAL trial |
| Study First Received: | August 19, 2011 |
| Last Updated: | August 22, 2011 |
| Health Authority: | Netherlands: The Central Committee on Research Involving Human Subjects (CCMO) |
Keywords provided by Erasmus Medical Center:
|
umbilical hernia cirrhosis ascites |
conservative surgery optimal management |
Additional relevant MeSH terms:
|
Liver Cirrhosis Ascites Hernia Hernia, Umbilical Fibrosis Pathologic Processes |
Pathological Conditions, Anatomical Infant, Newborn, Diseases Hernia, Ventral Hernia, Abdominal Liver Diseases Digestive System Diseases |
ClinicalTrials.gov processed this record on May 19, 2013