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Functional Outcome After Incisional Hernia Repair: Open Versus Laparoscopic Repair (GINCISHERNIA)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00625053
Recruitment Status : Unknown
Verified April 2008 by University Hospital, Geneva.
Recruitment status was:  Recruiting
First Posted : February 28, 2008
Last Update Posted : April 15, 2008
Information provided by:
University Hospital, Geneva

Brief Summary:

Background: Midline incisional hernia is reported from 0,5 to 11% after abdominal operations. Primary repair without mesh reinforcement is almost abandoned because of high recurrence rates (24 to 46%). Use of prosthetic mesh in incisional hernia repair lowered the recurrence rates under 10%. Recurrence rate alone is not the main quality criterion for incisional hernia repair anymore. Large series and meta-analyses confirmed the value of laparoscopic repair as at least equal if not better compared with open repair. Discomfort, pain, diminished quality of life and body image alteration influences functional well being. No baseline information exists in any of these fields treating pre- or post-operative phases in patients with incisional hernia. Respiratory functions and medico-economic evaluation are other rarely investigated fields that we consider in our trial. The objective of this study is to analyse the functional outcome status of patients after laparoscopic incisional hernia repair compared to open repair.

Methods: A randomized controlled non-blinded clinical trial is designed to compare laparoscopic incisional hernia mesh repair with open repair on post operative pain, health related quality of life outcomes, body image and cosmetic measurements, respiratory functions, recurrence rates, and cost. Volunteers will be recruited in Geneva University Hospital, department of surgery, visceral surgery unit. Eligibility criteria is male patient aged over 18 years, with reducible incisional hernia who are candidates for elective surgery and medically fit for general anesthesia.30 patients will be enrolled for each group. Follow-up will take place at 10th, 30th days as well as 3 12 and 24 post operative months by questionnaires and by clinical exam by independent expert. An overall cost-analysis will be realized. Patient enrollment in the study will start in April 2008 and estimated to end in september 2009.

Condition or disease Intervention/treatment Phase
Hernia, Ventral Body Image Respiratory Function Tests Quality of Life Laparoscopy Procedure: Laparoscopic repair Procedure: Open midline incisional hernia repair Phase 4

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 60 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Abdominal Midline Incisional Hernia Repair and Functional Outcome: Randomized Controlled Trial to Compare Open and Laparoscopic Surgical
Study Start Date : April 2008
Estimated Primary Completion Date : September 2011
Estimated Study Completion Date : September 2011

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Hernia

Arm Intervention/treatment
Experimental: 1
Laparoscopic repair
Procedure: Laparoscopic repair
Complete adhesiolysis between viscera and abdominal wall, complete dissection of round ligament and subumbilical fatty tissue to expose the posterior fascia at least 5 cm further than the cranial and caudal limits of the fascial defect or the original incision. Overlap of minimum 5 cm is calculated and mesh inserted in the abdominal cavity through 12mm optical trocar. Fixation of a antiadhesive composite mesh with helicoidal pins with maximum 15mm interval, double crown technique. No pressure decrease maneuver is done during mesh fixation or at another time during the operation. No transparietal suture fixation. No fascial closure.
Other Name: TIP

Active Comparator: 2
Open repair
Procedure: Open midline incisional hernia repair
  • Underlay retromuscular repair: Medial border of the anterior fascia opened, posterior aspect of rectus muscle dissected to reach lateral border of rectus sheet, bilaterally. Peritoneum and posterior rectus fascia closed with absorbable running suture. Polyester or light-weight polypropylene mesh is cut to fit the reconstructed area, to have 3cm overlap on caudal and cranial defect limits. Mesh is fixed by absorbable sutures. Anterior fascia is closed with absorbable running suture. Components separation upon need.
  • Intraperitoneal onlay repair: Mesh is inserted intraperitoneally and fixed by a complete running suture (optional fixation with helicoidal pins or stapler). Fascial defect is closed with interrupted or running absorbable suture. Components separation upon need.
Other Name: Stoppa-Rives

Primary Outcome Measures :
  1. Does Laparoscopic repair generate better functional outcome compared to the open mesh repair. Functional outcome includes pain, quality of life, body image and cosmetic measurements. [ Time Frame: Preoperative, 10, 30, 90, 365 and 730 postoperative days ]

Secondary Outcome Measures :
  1. Respiratory function [ Time Frame: Preoperative, 10, 90 and 365 postoperative days ]
  2. Influence of neuroticism on overall outcome [ Time Frame: Preoperative, 10, 30, 90, 365 and 730 postoperative days ]
  3. Postoperative surgical and medical complications [ Time Frame: Preoperative, 10, 30, 90, 365 and 730 postoperative days ]
  4. Overall cost analysis [ Time Frame: Two years after the operation ]
  5. Recurrence rate [ Time Frame: Two years after the operation ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 70 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Informed consent
  • Age 18 years or older
  • Diagnosis of reducible incisional hernias up to 200 cm²
  • Medically fit for general anesthesia
  • Comprehension and use of French language
  • Installed in the geographical region without foreseeable move for two years

Exclusion Criteria:

  • Incarcerated hernia
  • Ongoing chronic pain syndrome, other than hernia origin
  • Coagulation disorders, prophylactic or therapeutic anticoagulation, unable to stop platelet antiaggregation therapy 10 days before surgery
  • American Society of Anesthesiology Class 4 and 5 patients
  • Emergency surgery, peritonitis, bowel obstruction, strangulation, perforation
  • Mentally ill patients
  • Presence of local or systemic infection
  • Life expectancy < 2 years
  • Any cognitive impairment (Psychiatric disorder, Alzheimer's disease etc.)
  • Morbid obesity (BMI over 40)

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00625053

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Contact: Ihsan INAN, M.D. +41223723311 ext 6858149

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Geneva University Hospital, Department of Surgery, Visceral Surgery Division Recruiting
Geneva, Switzerland, 1211
Contact: Ihsan INAN, M.D.    +41223723311 ext 6858149   
Principal Investigator: Ihsan INAN, M.D.         
Sponsors and Collaborators
University Hospital, Geneva
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Study Chair: Philippe MOREL, Prof. Geneva University Hospital, Departement of Surgery, Visceral Surgery Division
Study Director: Ihsan INAN, M.D. Geneva University Hospital, Departement of Surgery, Visceral Surgery Division
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Responsible Party: Ihsan INAN M.D., Geneva University Hospital, Department of Surgery, Visceral Surgery Division Identifier: NCT00625053    
Other Study ID Numbers: 06-293
First Posted: February 28, 2008    Key Record Dates
Last Update Posted: April 15, 2008
Last Verified: April 2008
Keywords provided by University Hospital, Geneva:
Hernia, ventral
Quality of life
Additional relevant MeSH terms:
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Incisional Hernia
Hernia, Ventral
Pathological Conditions, Anatomical
Postoperative Complications
Pathologic Processes
Hernia, Abdominal