Usefulness of a Prothetic Absorbable Mesh in Incisional Hernia Prevention After Midline Laparotomy

NCT ID: NCT02208557

Last Updated: 2014-08-05

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

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

488 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-07-31

Study Completion Date

2015-07-31

Brief Summary

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Background: Development of an incisional hernia is one of the most frequent complications of midline laparotomies requiring reoperation. This paper presents the rationale, design, and study protocol for a randomized controlled trial, the aim of which was to evaluate the efficacy and safety of prophylactically placing a bioabsorbable synthetic mesh for reinforcement of a midline fascial closure.

Methods: The PREBIOUS trial (PREventive midline laparotomy closure with a BIOabsorbable mesh) is a multicenter randomized controlled trial in which adult patients undergoing elective or urgent open abdominal operations through a midline laparotomy incision are assigned to one of two groups based on the laparotomy closure procedure: an intervention group in which a continuous polydioxanone (PDS) suture is reinforced with a commercially available GORE® BIO-A® Tissue Reinforcement prosthesis (W. L. Gore \& Associates, Flagstaff, Arizona, USA), or a control group with continuous PDS suture only. Both groups are followed over 6 months.

Outcomes: The primary outcome is the appearance of incisional hernias assessed by physical examination at clinical visits and radiologically (CT scan) performed at the end of follow-up. Secondary outcomes are the rate of complications, mainly infection, hematoma, burst abdomen, pain, and reoperation. The PREBIOUS trial has the potential to demonstrate that suture plus prosthetic mesh insertion for routine midline laparotomy closure is effective in preventing incisional hernias after open abdominal surgery, to avoid the effects on those affected, such as poor cosmesis, social embarrassment, or impaired quality of life, and to save costs potentially associated with incisional hernia surgical repair.

Detailed Description

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Conditions

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Incisional Hernia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Control

Laparotomy closure will be done by continuous PDS suture following a SL:WL ratio of 4:1 only is used for midline laparotomy closure.

Group Type ACTIVE_COMPARATOR

Control CT

Intervention Type RADIATION

At the end of the follow up (6 Months) a CT scan will be done. Radiologically the incisional hernia is defined as a solution of continuity of the linea alba seen on the abdominal CT scan with the patient at rest.

The radiologist is blinded to the patient's history and the technique used for midline fascial closure.

Clinical Follow Up

Intervention Type OTHER

The presence of incisional hernia was evaluated by physical examination at scheduled clinical visits (3 and 6 months after surgery) Clinically, an incisional hernia is defined as the presence of a reducible bulge or protrusion at the laparotomy incision scar, palpable during the Valsalva maneuver.

Reinforcement with Absorbable Mesh

Closure of the midline laparotomy incision is reinforced with insertion of a rectangular segment (1 cm wide and the length corresponding to the incision) of a prosthetic commercially available GORE® BIO-A® Tissue Reinforcement prosthesis (W. L. Gore \& Associates, Flagstaff, Arizona, USA) mesh. The BIO-A® prosthesis is inserted using a "sandwich" method between the edges of the incision and maintained in situ with a continuous polydioxanone (PDS) suture following a suture length to wound length (SL:WL) ratio of 4:1.

Group Type EXPERIMENTAL

Reinforcement with Absorbable Mesh

Intervention Type PROCEDURE

Control CT

Intervention Type RADIATION

At the end of the follow up (6 Months) a CT scan will be done. Radiologically the incisional hernia is defined as a solution of continuity of the linea alba seen on the abdominal CT scan with the patient at rest.

The radiologist is blinded to the patient's history and the technique used for midline fascial closure.

Clinical Follow Up

Intervention Type OTHER

The presence of incisional hernia was evaluated by physical examination at scheduled clinical visits (3 and 6 months after surgery) Clinically, an incisional hernia is defined as the presence of a reducible bulge or protrusion at the laparotomy incision scar, palpable during the Valsalva maneuver.

Interventions

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Reinforcement with Absorbable Mesh

Intervention Type PROCEDURE

Control CT

At the end of the follow up (6 Months) a CT scan will be done. Radiologically the incisional hernia is defined as a solution of continuity of the linea alba seen on the abdominal CT scan with the patient at rest.

The radiologist is blinded to the patient's history and the technique used for midline fascial closure.

Intervention Type RADIATION

Clinical Follow Up

The presence of incisional hernia was evaluated by physical examination at scheduled clinical visits (3 and 6 months after surgery) Clinically, an incisional hernia is defined as the presence of a reducible bulge or protrusion at the laparotomy incision scar, palpable during the Valsalva maneuver.

Intervention Type OTHER

Other Intervention Names

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GORE® BIO-A® Tissue Reinforcement prosthesis (W. L. Gore & Associates, Flagstaff, Arizona, USA) mesh. LNE/G-MED (CE) 0459

Eligibility Criteria

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Inclusion Criteria

* Adults aged 18 years or older,
* Signed informed consent,
* Patients undergoing elective or urgent open abdominal surgical procedures regardless of benign or malignant disease.

Exclusion Criteria

* Presence of primary or recurrent incisional hernia
* Expected survival \< 12 months.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hospital Universitari Vall d'Hebron Research Institute

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Manuel Lopez-Cano, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Hospital Universitari Vall d´Hebrón

Locations

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Hospital del Mar, Parc de Salut Mar

Barcelona, Barcelona, Spain

Site Status RECRUITING

Hospital Universitari Vall d'Hebron

Barcelona, Barcelona, Spain

Site Status RECRUITING

Hospital de Igualada

Igualada, Barcelona, Spain

Site Status RECRUITING

Hospital Parc Taulí

Sabadell, Barcelona, Spain

Site Status RECRUITING

Hospital Arnau de Vilanova

Lleida, Lerida, Spain

Site Status RECRUITING

Hospital de Sagunto

Sagunto, Valencia, Spain

Site Status RECRUITING

Countries

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Spain

Central Contacts

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Manuel Lopez-Cano, MD, PhD

Role: CONTACT

+34 - 932746000 ext. 6587

Facility Contacts

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Jose Antonio Pereira, Md, PhD

Role: primary

Manuel Lopez-Cano, MD, PhD

Role: primary

+34 - 93274600 ext. 6587

Xavier Feliú, MD, PhD

Role: primary

Salvador Navarro, MD, PhD

Role: primary

Rafael Villalobos, MD

Role: primary

Roberto Lozoya, MD, PhD

Role: primary

Other Identifiers

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PR(AG)220/2013

Identifier Type: -

Identifier Source: org_study_id

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