Reinforcement of Closure of Stoma Site

NCT ID: NCT02238964

Last Updated: 2018-10-11

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

COMPLETED

Clinical Phase

PHASE2/PHASE3

Total Enrollment

790 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-11-30

Study Completion Date

2018-05-18

Brief Summary

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ROCSS is a randomised controlled trial of the placement of a biological mesh at the site of stoma closure. Our hypothesis is that reinforcing the stoma closure site with a collagen mesh (Strattice®) is superior to the standard technique in preventing herniation at 2 years.

Detailed Description

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Closure of complex and contaminated abdominal wounds is challenging and carries risks, including wound dehiscence and incisional hernias. Use of biological meshes in these situations may provide a safe method of reducing these complications, especially long-term incisional hernias. ROCSS will use stoma site closure as a model for biological mesh placement during any difficult contaminated abdominal wall closures.

Hernia at the site of stoma closure occurs in up to 30% of patients and is associated with adverse effects on quality of life. In up to 10% of cases, patients are submitted to complex re-operation which carries significant morbidity. Not all patients will report symptoms or undergo repair, as they do not wish to have a further major operation. Incisional hernias at the site of stomas closure form an important and well defined subgroup. If there is a measurable benefit from mesh insertion, elective use of a collagen mesh would warrant consideration in the closure of other difficult, contaminated abdominal wounds. This study will also provide useful information on the value of using a CT scan as an early diagnostic tool of herniation, which could then be used in future abdominal wall studies as a surrogate endpoint for clinical hernia.

ROCSS aims to assess whether a biological mesh (collagen tissue matrix) reduces the incidence of clinically detectable stoma closure site hernias at two years compared to standard closure techniques. The primary outcome is Occurrence of clinically detectable hernias at two years post randomisation. Other outcomes include surgical re-intervention rate, surgical complications at 30 days post-operation and 1 year post-randomisation, quality of life and post-operative pain, cost-benefit analysis and radiological hernia rate at one year post-randomisation (an exploratory analysis will compare radiological hernia rate at 1 year with clinical hernia rate at 2 years to assess the value of using a CT scan as an early diagnostic tool of incisional hernias).

Randomisation is 1:1 between Strattice® mesh vs. standard closure. The sample size for the trial is 560 (80% power, 10% dropout/crossover, 40% proportional reduction - 25% to 15%) and recruitment will be over 2 years from at least 30 centres. ROCSS will be a double blind (observer blind) randomised controlled trial with a CT scan at one year and clinical follow up at 2 years. Cost benefit analysis and quality of life analysis will be performed at 2 years. The sample size will be reviewed prior to reaching target and may be increased 790 (90% power, 20% dropout/crossover, 40% proportional reduction - 25% to 15%).

Conditions

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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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Strattice™ Reconstructive Tissue Matrix

Strattice(TM) Reconstructive Tissue Matrix will be placed intra-peritoneally fashion. Once correctly placed, the fascia above will be closed using Prolene, PDS or Nylon (surgeon preference, but excluding Vicryl).

Group Type ACTIVE_COMPARATOR

Strattice™ Reconstructive Tissue Matrix

Intervention Type DEVICE

The protocol preference is for the mesh to be placed intra-peritoneally fashion (i.e. below the peritoneum). Anchoring bites will be taken in four to six sites of peritoneum (e.g. using 2-0 PDS) and the mesh will be 'parachuted' into place. Once correctly placed, the fascia above will be closed using Prolene, PDS or Nylon (surgeon preference, but excluding Vicryl). Infiltration of up to 40ml 0.25% Marcaine for infiltration into the fascial layer is recommended. The remainder of the closure will be at the surgeon's discretion.

Standard closure

Fascial closure will be the preferred technique of the surgeon without mesh reinforcement. The technique recommended is the fascia should be closed with Prolene, PDS or nylon sutures; Vicryl should not be used for the fascia. This technique can include either interrupted or continuous sutures.

Closure of the muscle, soft tissues and skin is up to the discretion of the operating surgeon.

Group Type ACTIVE_COMPARATOR

Standard Closure

Intervention Type PROCEDURE

The non-intervention arm for fascial closure will be the preferred technique of the surgeon without mesh reinforcement. The fascia should be closed with Prolene, PDS or nylon sutures; Vicryl should not be used for the fascia. The remainder of the closure will be at the surgeon's discretion.

Interventions

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Strattice™ Reconstructive Tissue Matrix

The protocol preference is for the mesh to be placed intra-peritoneally fashion (i.e. below the peritoneum). Anchoring bites will be taken in four to six sites of peritoneum (e.g. using 2-0 PDS) and the mesh will be 'parachuted' into place. Once correctly placed, the fascia above will be closed using Prolene, PDS or Nylon (surgeon preference, but excluding Vicryl). Infiltration of up to 40ml 0.25% Marcaine for infiltration into the fascial layer is recommended. The remainder of the closure will be at the surgeon's discretion.

Intervention Type DEVICE

Standard Closure

The non-intervention arm for fascial closure will be the preferred technique of the surgeon without mesh reinforcement. The fascia should be closed with Prolene, PDS or nylon sutures; Vicryl should not be used for the fascia. The remainder of the closure will be at the surgeon's discretion.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Require an elective closure of an ileostomy or a colostomy.
* Able and willing to provide written informed consent.
* Aged 18 years or over.

Exclusion Criteria

* Taking part in another clinical study which is related to the surgical procedure.
* Allergic to any porcine or collagen products.
* History of familial adenomatous polyposis, due to increased risk of desmoid tumours.
* The surgeon determines that a mesh repair will definitely be required e.g. due to large parastomal hernia.
* Unable or unwilling to provide written informed consent.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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LifeCell

INDUSTRY

Sponsor Role collaborator

University of Birmingham

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Dion G Morton, MD

Role: PRINCIPAL_INVESTIGATOR

Professor of Colorectal Surgery

Locations

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Hvidovre Hospital

Copenhagen, , Denmark

Site Status

Academisch Medisch Centrum

Amsterdam, , Netherlands

Site Status

Tameside General Hospital

Ashton-under-Lyne, , United Kingdom

Site Status

Royal United Hospital Bath

Bath, , United Kingdom

Site Status

Heart of England NHS Foundation Trust

Birmingham, , United Kingdom

Site Status

Queen Elizabeth Hospital

Birmingham, , United Kingdom

Site Status

Sandwell General Hospital

Birmingham, , United Kingdom

Site Status

Pilgrim Hospital

Boston, , United Kingdom

Site Status

Bristol Royal Infirmary

Bristol, , United Kingdom

Site Status

Broomfield Hospital

Chelmsford, , United Kingdom

Site Status

St Peters Hospital

Chertsey, , United Kingdom

Site Status

Chesterfield Royal Hospital

Chesterfield, , United Kingdom

Site Status

Western Sussex Hospitals NHS Foundation Trust

Chichester, , United Kingdom

Site Status

University Hospital Coventry

Coventry, , United Kingdom

Site Status

Doncaster Royal Infirmary

Doncaster, , United Kingdom

Site Status

Dorset Country Hospital

Dorchester, , United Kingdom

Site Status

James Paget University Hospital

Great Yarmouth, , United Kingdom

Site Status

St Marks Hospital

Harrow, , United Kingdom

Site Status

Raigmore Hospital

Inverness, , United Kingdom

Site Status

University Hospitals of Leicester NHS Trust

Leicester, , United Kingdom

Site Status

Macclesfield District General Hospital

Macclesfield, , United Kingdom

Site Status

Queen Elizabeth the Queen Mother Hospital

Margate, , United Kingdom

Site Status

Norfolk & Norwich University Hospital

Norwich, , United Kingdom

Site Status

Queens Medical Centre

Nottingham, , United Kingdom

Site Status

Salisbury District Hospital

Salisbury, , United Kingdom

Site Status

University Hospital of North Tees

Stockton-on-Tees, , United Kingdom

Site Status

Royal Stoke University Hospital

Stoke-on-Trent, , United Kingdom

Site Status

Kings Mill Hospital

Sutton in Ashfield, , United Kingdom

Site Status

Manor Hospital

Walsall, , United Kingdom

Site Status

Royal Albert Edward Infirmary

Wigan, , United Kingdom

Site Status

New Cross Hosptial

Wolverhampton, , United Kingdom

Site Status

Worcestershire Royal Hospital

Worcester, , United Kingdom

Site Status

Wythenshawe Hosptial

Wythenshawe, , United Kingdom

Site Status

Yeovil District Hospital

Yeovil, , United Kingdom

Site Status

York Hospital

York, , United Kingdom

Site Status

Countries

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Denmark Netherlands United Kingdom

References

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Reinforcement of Closure of Stoma Site (ROCSS) Collaborative and West Midlands Research Collaborative. Prophylactic biological mesh reinforcement versus standard closure of stoma site (ROCSS): a multicentre, randomised controlled trial. Lancet. 2020 Feb 8;395(10222):417-426. doi: 10.1016/S0140-6736(19)32637-6.

Reference Type DERIVED
PMID: 32035551 (View on PubMed)

Reinforcement of Closure of Stoma Site (ROCSS) Collaborative and the West Midlands Research Collaborative. Feasibility study from a randomized controlled trial of standard closure of a stoma site vs biological mesh reinforcement. Colorectal Dis. 2016 Sep;18(9):889-96. doi: 10.1111/codi.13310.

Reference Type DERIVED
PMID: 26924621 (View on PubMed)

Related Links

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Other Identifiers

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46330337

Identifier Type: REGISTRY

Identifier Source: secondary_id

13461

Identifier Type: REGISTRY

Identifier Source: secondary_id

12/WM/0187

Identifier Type: OTHER

Identifier Source: secondary_id

RG_11-186

Identifier Type: -

Identifier Source: org_study_id

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