An International Double Cohort Study to Compare Laparoscopic Ventral Rectopexy With Laparoscopic Resection Rectopexy

NCT ID: NCT01595412

Last Updated: 2017-10-24

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

2 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-01-31

Study Completion Date

2017-10-31

Brief Summary

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Background:

Rectal prolapse (RP) is the descent of the upper rectum and is a common problem in the western world. Surgery is the only definite treatment and is preferably performed minimally invasive. High-level prospective studies on treatment strategies for RP currently are lacking and, thus, no consensus exist regarding the optimal treatment for patients with RP. Furthermore, remarkable transatlantic differences exist, as in Europe, laparoscopic ventral rectopexy (LVR) is regarded the treatment of choice, while in the USA Laparoscopic Resection Rectopexy (LRR) remains the golden standard.

Objective:

To determine the optimal minimally invasive surgical treatment for patients with RP.

Design:

International, prospective, comparative double cohort study. The first cohort will consist of 120 European patients with a RP and will be treated with LVR. Centres in The Netherlands, Belgium and the UK are enlisted for participation. The second cohort will consist of 120 American patients with a RP, treated with LRR. Several US centres are enlisted. Preoperative work-up consists of radiological imaging and standardised questionnaires. Follow-up (FU) is set on two years. During FU, pre-operative imaging and questionnaires will be repeated.

Primary \& secondary outcomes:

Primary endpoint will be improvement on the Gastro-Intestinal-Quality-of-Life-Index (GIQLI). Secondary endpoints will be generic Quality-of-Life, functional results, morbidity, mortality, recurrences and cost-effectiveness.

Time frame:

Study and inclusion start will be on January the 1st, 2011 and will take approximately 18-24 months. Therefore, total study duration will be 42-48 months.

Detailed Description

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A Rectal Prolapse (RP), or procidentia, is the descent of the upper rectum. This descensus in the full-thickness of the rectum, and can be either internal, called an internal rectal prolapse or intussusception (IRP), or through the anus (called an external rectal prolapse (ERP)).

RP mainly occurs in women (80-90%) of which most in the 6-7th decade. Risk factors for developing a rectal prolapse are the presence of an abnormal deep pouch of Douglas, laxity and atonic condition of the muscles of the pelvic floor and anal canal. Moreover, weakness of both internal and external sphincters, often with evidence of pudendal nerve neuropathy and the lack of normal fixation of the rectum may lead to RP. This also frequently leads to other pelvic organ prolapses like vesicoceles, enteroceles and genital prolapses. In this study the investigators will focus on the treatment of RP.

Rectal prolapses cause anal incontinence in more than half of the patients. Another frequent symptom of RP is constipation. Furthermore, the rectal prolapse can lead to anal pain as a result of incarceration leading to ulcers, necrosis and perforation.

Besides the fact that this disease has a considerable impact on the individual quality of life, it also carries significant socio-economic consequences as incontinence products have to be used in large amounts.

Conditions

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Rectal Prolapse Procidentia

Keywords

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Laparoscopic surgery Colorectal Surgery Quality of Life Rectal Prolapse Anorectal Physiology

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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Cohort 2

Cohort 2 (two) will consist of 120 patients with an external rectal prolapse (Oxford Grade V)treated by Laparoscopic Resection Rectopexy (LRR). These patients will be included in the US centers involved in this study and treated by LRR.

Group Type ACTIVE_COMPARATOR

Laparoscopic Resection Rectopexy

Intervention Type PROCEDURE

laparoscopic sigmoidectomy with suture rectopexy

Cohort 1

Cohort one will consist of 120 patients with an external rectal prolapse (Oxford Grade V) which will be treated with Laparoscopic Ventral Rectopexy. As this is the standard treatment in the European centers involved in this study these patients will be selected in the participating centers in the Netherlands, Belgium and England.

Group Type ACTIVE_COMPARATOR

Laparoscopic Ventral Rectopexy

Intervention Type PROCEDURE

laparoscopic ventral rectopexy with mesh

Interventions

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Laparoscopic Resection Rectopexy

laparoscopic sigmoidectomy with suture rectopexy

Intervention Type PROCEDURE

Laparoscopic Ventral Rectopexy

laparoscopic ventral rectopexy with mesh

Intervention Type PROCEDURE

Other Intervention Names

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Laparoscopic Resection Rectopexy, Laparoscopic ventral mesh rectopexy Ventral mesh rectopexy

Eligibility Criteria

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Inclusion Criteria

* All patients with an indication for Laparoscopic Resection Rectopexy\* for External Rectal Prolapse (Oxford Grade V)

Exclusion Criteria

* Under 18 years of age
* Former rectosigmoid resection
* Former rectal prolapse surgery
* Rectosigmoid tumor
* Severe mental retardation
* Pregnant women
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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The Cleveland Clinic

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Steven D Wexner, MD

Role: PRINCIPAL_INVESTIGATOR

Cleveland Clinic Floria

Locations

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The Florida Hospital

Orlando, Florida, United States

Site Status

Tampa General Hospital

Tampa, Florida, United States

Site Status

Cleveland Clinic Floria

Weston, Florida, United States

Site Status

Oschner Clinic North Shore

New Orleans, Louisiana, United States

Site Status

John Hopkins

Baltimore, Maryland, United States

Site Status

Lahey Medical Center

Burlington, Massachusetts, United States

Site Status

Countries

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United States

Other Identifiers

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NTR2743

Identifier Type: -

Identifier Source: org_study_id