Diverting Loop Ileostomy: With or Without Rod

NCT ID: NCT00959738

Last Updated: 2014-11-14

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

NA

Total Enrollment

121 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-08-31

Study Completion Date

2014-11-30

Brief Summary

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Diverting ileostomies are created to protect a rectal anastomosis or in situations with a risk of intestinal perforation. Currently, the application of a rod to hinder slippage of the loop is an established technique to perform a diverting loop ileostomy. However, various "rod-less" techniques have been described and are performed with similar success. The aim of this study is to determine, whether a modification (without rod) of the current standard method of protective loop ileostomy formation (with rod) could improve ileostomy specific morbidity. Secondary endpoints include stoma care, determinants of quality of life and stoma function.

Detailed Description

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Background

For rectal anastomoses within 6 cm of the anal verge, leakage rates are up to 15%. Here liberal use of protective stomas is widely accepted. Fecal diversion by loop ostomy may also be performed after extended adhesiolysis with serosal lesions and risk of intestinal perforation, in patients with obstructing rectal tumours requiring neoadjuvant radio-chemotherapy or in patients with complex anorectal injuries or fistulas. Generally, diverting loop ileostomies are secured at skin level by means of a supporting device in order to prevent retraction of the loop ileostomy into the abdomen. Nevertheless, due to the supporting rod, difficulties may occur in applying a stoma bag correctly and leakage of feces onto the skin may occur even with correct eversion of the afferent limb. Despite easier application of stoma bags and therefore reduced risk of skin irritation, none of these alternative techniques are established. In various non-randomized studies rodless loop ileostomies were described with an overall morbidity between 3 and 39%. However definition of morbidity varies significantly in these studies and randomised controlled trials are missing so far.

Objective

The aim of this study is to determine, whether a modification (without rod) of the current standard method of protective loop ileostomy formation (with rod) could improve ileostomy specific morbidity. Secondary endpoints include stoma care, determinants of quality of life and stoma function.

Methods

The study is designed as multi-institutional, randomized controlled, two-armed study. Patients scheduled for a protective loop ileostomy and meeting the eligibility criteria will be randomized to creation of a loop ileostomy with or without sustaining rod.

Conditions

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Ileostomy Rectal Neoplasms

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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A

diverting loop ileostomy with rod

Group Type OTHER

Diverting loop ileostomy with rod

Intervention Type PROCEDURE

Diverting loop ileostomy with rod

B

diverting loop ileostomy without rod

Group Type OTHER

diverting loop ileostomy without rod

Intervention Type PROCEDURE

diverting loop ileostomy without rod

Interventions

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Diverting loop ileostomy with rod

Diverting loop ileostomy with rod

Intervention Type PROCEDURE

diverting loop ileostomy without rod

diverting loop ileostomy without rod

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* patients scheduled for planned protective loop ileostomy

Exclusion Criteria

* patients with long-term use of corticosteroids (\> 15 mg prednisolone equivalent)
* immunosuppressive agent rapamune
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Insel Gruppe AG, University Hospital Bern

OTHER

Sponsor Role lead

Responsible Party

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Bern University Hospital, Department of Visceral Surgery

Principal Investigators

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Lukas E Bruegger, MD

Role: PRINCIPAL_INVESTIGATOR

Bern University Hospital,Dep. of Visceral and Transplant Surgery Switzerland

Locations

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Bern University Hospital, Dep. of Visceral and Transplant Surgery

Bern, , Switzerland

Site Status

Countries

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Switzerland

References

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Rosen HR, Schiessel R. [Loop enterostomy]. Chirurg. 1999 Jun;70(6):650-5. doi: 10.1007/s001040050701. German.

Reference Type BACKGROUND
PMID: 10427451 (View on PubMed)

Gastinger I, Marusch F, Steinert R, Wolff S, Koeckerling F, Lippert H; Working Group 'Colon/Rectum Carcinoma'. Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg. 2005 Sep;92(9):1137-42. doi: 10.1002/bjs.5045.

Reference Type BACKGROUND
PMID: 15997447 (View on PubMed)

Moran B, Heald R. Anastomotic leakage after colorectal anastomosis. Semin Surg Oncol. 2000 Apr-May;18(3):244-8. doi: 10.1002/(sici)1098-2388(200004/05)18:33.0.co;2-6.

Reference Type BACKGROUND
PMID: 10757890 (View on PubMed)

Karanjia ND, Corder AP, Bearn P, Heald RJ. Leakage from stapled low anastomosis after total mesorectal excision for carcinoma of the rectum. Br J Surg. 1994 Aug;81(8):1224-6. doi: 10.1002/bjs.1800810850.

Reference Type BACKGROUND
PMID: 7953369 (View on PubMed)

Silva MA, Ratnayake G, Deen KI. Quality of life of stoma patients: temporary ileostomy versus colostomy. World J Surg. 2003 Apr;27(4):421-4. doi: 10.1007/s00268-002-6699-4.

Reference Type BACKGROUND
PMID: 12658485 (View on PubMed)

Amin SN, Memon MA, Armitage NC, Scholefield JH. Defunctioning loop ileostomy and stapled side-to-side closure has low morbidity. Ann R Coll Surg Engl. 2001 Jul;83(4):246-9.

Reference Type BACKGROUND
PMID: 11518371 (View on PubMed)

Edwards DP, Leppington-Clarke A, Sexton R, Heald RJ, Moran BJ. Stoma-related complications are more frequent after transverse colostomy than loop ileostomy: a prospective randomized clinical trial. Br J Surg. 2001 Mar;88(3):360-3. doi: 10.1046/j.1365-2168.2001.01727.x.

Reference Type BACKGROUND
PMID: 11260099 (View on PubMed)

Bada-Yllan O, Garcia-Osogobio S, Zarate X, Velasco L, Hoyos-Tello CM, Takahashi T. [Morbi-mortality related to ileostomy and colostomy closure]. Rev Invest Clin. 2006 Nov-Dec;58(6):555-60. Spanish.

Reference Type BACKGROUND
PMID: 17432286 (View on PubMed)

Goldstein ET, Williamson PR. A more functional loop ileostomy rod. Dis Colon Rectum. 1993 Mar;36(3):297-8. doi: 10.1007/BF02053516.

Reference Type BACKGROUND
PMID: 8449139 (View on PubMed)

Unti JA, Abcarian H, Pearl RK, Orsay CP, Nelson RL, Prasad ML, Duarte B, Leff MM, Tan AB. Rodless end-loop stomas. Seven-year experience. Dis Colon Rectum. 1991 Nov;34(11):999-1004. doi: 10.1007/BF02049964.

Reference Type BACKGROUND
PMID: 1935478 (View on PubMed)

Other Identifiers

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061/08

Identifier Type: -

Identifier Source: org_study_id