Role of Prosthetic Mesh in Preventing Parastomal Hernias (RPMPPH)
Introduction Parastomal hernia is the most common complication related to colostomies. The variability of the diagnostic criteria, the fallow up time and sometimes subclinical dimensions, detectable only with imaging, explain disparate figures cited in the literature (0-58%) (1). The generally accepted rate is around 50% (2). However, several authors consider that actually, almost all patients present parastomal hernia in the long-term fallow up (3).
Prophylactic prosthetic meshes could reduce the incidence of this complication, reinforcing since the beginning the weak peristomal area of the abdominal wall. Existing scientific evidence, although positive, is limited and does not allow to clarify some controversial issues as the type of prosthetic mesh to be used and the optimal position of the mesh in relation to the abdominal wall (4-8).
The use of laparoscopic approach in colorectal surgery is increasing and also sets technical changes to the placement of the mesh. To date, there are some technical notes (9) and two published prospective, observational studies that include patients underwent laparoscopic surgery. In the first study intraperitoneal (10) and in the second retromuscular mesh (11) is used, with encouraging short-term results, but they need more scientific support.
Study Design This is a prospective, randomized, single center, clinical study where the sample is represented by patients undergoing elective laparoscopy assisted colorectal surgery, with the creation of a permanent end colostomy. Patients who accept to participate and are suitable for inclusion to the study will be randomized into one of the two branches consecutively: Treatment A: Conventional definitive end colostomy; Treatment B: Definitive end colostomy reinforced by retromuscular mesh Ultrapro.
Aims Evaluate and compare the results obtained by placing prosthetic mesh to prevent parastomal hernia end colostomy versus realization of end colostomy by conventional technique.
Primary Objective: Compare the incidence of parastomal hernias between groups during the monitoring period.
Secondary objectives: Compare the overall and specific postoperative morbidity and mortality between groups, compare the difference in surgical time between the conventional technique and the prosthetic mesh group, compare hospital stay between the groups.
|Parastomal Hernia||Device: Definitive end colostomy with mesh Other: Conventional definitive end colostomy||Phase 3|
|Study Design:||Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Prevention
|Official Title:||Prospective Randomized Study of the Role of Prosthetic Mesh in Preventing Parastomal Hernias in Patients With Definitive End Colostomy|
- Compare the incidence of parastomal hernias between groups [ Time Frame: During the monitoring period of one year ]
Monitoring will be realized with clinical controls (after 15 days and 2, 6, 12 months) and with an abdominal computed tomography in the first year.
The expected result is the statistically significant reduction in the incidence of parastomal hernias in patients undergoing elective laparoscopy assisted colorectal surgery with realization of end colostomy reinforced with retromuscular mesh collocation
- Compare the overall and specific postoperative morbidity and mortality between groups [ Time Frame: During the monitoring period of one year ]Monitoring will be realized with clinical controls (after 15 days and 2, 6, 12 months) and with an abdominal computed tomography in the first year
- Compare the difference in surgical time between the conventional technique and the prosthetic mesh group [ Time Frame: During the surgery ]The duration of the surgery will be compared bentween the groups
- Compare hospital stay between the groups [ Time Frame: Patientes will be followed for the duration of hospital stay, an expected average of 14 days ]Days of hospital stay will be compared between the groups
|Study Start Date:||March 2013|
|Estimated Study Completion Date:||October 2016|
|Estimated Primary Completion Date:||October 2015 (Final data collection date for primary outcome measure)|
Experimental: Creation of defitinive end colostomy
Patients undergoing elective laparoscopy assisted colorectal surgery, with the creation of a permanent end colostomy
Device: Definitive end colostomy with mesh
In the mesh group, a synthetic prosthetic mesh low weight type Ultrapro (15x15 cm) will be used. It will be placed in a sublay position between the rectus abdominis muscle and the posterior rectus sheath, will be sutured to the posterior rectus sheath with absorbable multifilament stitches. Once positioned and fixed the mesh the bowel will be brought out through a cross cut in the center of the mesh Finally, colon will be fixed by colocutaneous end to end absorbable multifilament sutures.
Other Names:Other: Conventional definitive end colostomy
Show Detailed Description
Please refer to this study by its ClinicalTrials.gov identifier: NCT01955278
|Contact: Ozlem Uyanik, MDemail@example.com|
|Hospital de Santa Creu i Sant Pau||Recruiting|
|Barcelona, Spain, 08040|
|Contact: Ozlem Uyanik, MD 0034677840299 firstname.lastname@example.org|
|Principal Investigator: Ozlem Uyanik, MD|
|Principal Investigator: Eduardo Targarona, MD|
|Principal Investigator: Carmen Balague, MD|
|Principal Investigator: Pilar Hernandez, MD|
|Principal Investigator: Carmen Martinez, MD|
|Principal Investigator: Jesus Bollo, MD|
|Principal Investigator: Manuel Trias, MD|
|Principal Investigator: Sorin Mocanu, MD|
|Principal Investigator: Luis Pallares, MD|
|Study Director:||Eduardo Targarona, MD||Hospital de Santa Creu i Sant Pau, Barcelona, Spain|