Loop Ileostomy Closure:Stapled or Hand-sewn Anastomoses? Suture or Mesh Closure of the Stoma Site?

NCT ID: NCT02669992

Last Updated: 2023-01-26

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

RECRUITING

Clinical Phase

NA

Total Enrollment

400 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-06-30

Study Completion Date

2027-12-31

Brief Summary

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There are severel problems associated with the closing of a temporary loop-ileostomy after surgery for rectal cancer. The purpose of this study is to answer two questions:

1. The choice of anastomotic method - does it influence the postoperative course?
2. The use of a prophylactic mesh when closing the stoma site - will there be less hernias?

Detailed Description

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Postoperative complications after closure of a temporary loop ileostomy after rectal cancer surgery are common. In this study the investigators propose the hypothesis that a stapled anastomotic technique will decrease postoperative small bowel obstruction and a mesh closure of the stoma site in the abdominal wall will decrease hernia formation.

All patients will be randomized to stapled or hand-sewn anastomosis. The randomization to mesh or suture closure of the abdominal wall is optional.

The stapled anastomotic technique is performed by the use of a linear staple device and the hand-sewn technique with a running seromuscular monofilament suture.

The stoma site has two options and will be closed either by the use of mesh (lightweight), positioned under the muscle (retromuscular), or just by long-lasting suture. The anterior fascia of the rectus as well as the skin are closed by the use of running monofilament longlasting sutures, the latter in a pursestring procedure.

Conditions

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Rectal Neoplasm

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Participants

Study Groups

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Stapled anastomosis

Stapled anastomosis by the use of commercially available linear stapler device

Group Type EXPERIMENTAL

Stapled or Hand-sewn anastomosis

Intervention Type PROCEDURE

Randomization between stapled or hand-sewn anastomosis

Hand-sewn anastomosis

Hand-sewn by the use of a resorbable monofilament suture

Group Type ACTIVE_COMPARATOR

Stapled or Hand-sewn anastomosis

Intervention Type PROCEDURE

Randomization between stapled or hand-sewn anastomosis

Abdominal wall mesh closure

Closure by the use of a mesh low-weight net device

Group Type EXPERIMENTAL

Mesh or suture stoma site closure

Intervention Type PROCEDURE

Randomization between suture or Mesh closure of the stoma site

Abdominal wall suture closure

Closure by the use of slowly absorbing monofilament suture

Group Type ACTIVE_COMPARATOR

Mesh or suture stoma site closure

Intervention Type PROCEDURE

Randomization between suture or Mesh closure of the stoma site

Interventions

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Stapled or Hand-sewn anastomosis

Randomization between stapled or hand-sewn anastomosis

Intervention Type PROCEDURE

Mesh or suture stoma site closure

Randomization between suture or Mesh closure of the stoma site

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* loop ileostomy after rectal cancer surgery
* loop ileostomy closure is permitted and possible according to clinical practice

Exclusion Criteria

* patient unable to understand written or oral information
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Karolinska University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Ulrik Lindforss

Associate professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Ulrik Lindforss, A.P

Role: PRINCIPAL_INVESTIGATOR

Karolinska University Hospital

Locations

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Sahlgrenska Universitetssjukhuset, Östra sjukhuset

Gothenburg, , Sweden

Site Status RECRUITING

Centralsjukhuset Karlstad

Karlstad, , Sweden

Site Status RECRUITING

Sunderby Sjukhus

Luleå, , Sweden

Site Status RECRUITING

Lycksele lasarett

Lycksele, , Sweden

Site Status RECRUITING

Norrtälje sjukhus

Norrtälje, , Sweden

Site Status RECRUITING

Östersunds sjukhus

Östersund, , Sweden

Site Status RECRUITING

Skellefteå lasarett

Skellefteå, , Sweden

Site Status RECRUITING

Danderyds sjukhus

Stockholm, , Sweden

Site Status RECRUITING

Karolinska universitetssjukhuset

Stockholm, , Sweden

Site Status RECRUITING

Norrlands Universitets Sjukhus

Umeå, , Sweden

Site Status RECRUITING

Region Gotland

Visby, , Sweden

Site Status RECRUITING

Countries

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Sweden

Central Contacts

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Pontus Gustafsson, MD

Role: CONTACT

+46703272152

Facility Contacts

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Petra wieveg, MD

Role: primary

Claes Erixon

Role: primary

Christoffer Odensten

Role: primary

Rebecka Zacharias

Role: primary

Pär Nordin

Role: primary

Mats Hjortborg

Role: primary

Ylva Falken, MD

Role: primary

Ulrik Lindforss

Role: primary

Ulf Gunnarsson, prof

Role: primary

Pontus Gustafsson, MD

Role: primary

+46703272152

References

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Gustavsson K, Gunnarsson U, Jestin P. Postoperative complications after closure of a diverting ileostoma--differences according to closure technique. Int J Colorectal Dis. 2012 Jan;27(1):55-8. doi: 10.1007/s00384-011-1287-4. Epub 2011 Aug 16.

Reference Type BACKGROUND
PMID: 21845418 (View on PubMed)

Gong J, Guo Z, Li Y, Gu L, Zhu W, Li J, Li N. Stapled vs hand suture closure of loop ileostomy: a meta-analysis. Colorectal Dis. 2013;15(10):e561-8. doi: 10.1111/codi.12388.

Reference Type BACKGROUND
PMID: 24033921 (View on PubMed)

Rubio-Perez I, Leon M, Pastor D, Diaz Dominguez J, Cantero R. Increased postoperative complications after protective ileostomy closure delay: An institutional study. World J Gastrointest Surg. 2014 Sep 27;6(9):169-74. doi: 10.4240/wjgs.v6.i9.169.

Reference Type BACKGROUND
PMID: 25276286 (View on PubMed)

Akiyoshi T, Fujimoto Y, Konishi T, Kuroyanagi H, Ueno M, Oya M, Yamaguchi T. Complications of loop ileostomy closure in patients with rectal tumor. World J Surg. 2010 Aug;34(8):1937-42. doi: 10.1007/s00268-010-0547-8.

Reference Type BACKGROUND
PMID: 20372898 (View on PubMed)

Chude GG, Rayate NV, Patris V, Koshariya M, Jagad R, Kawamoto J, Lygidakis NJ. Defunctioning loop ileostomy with low anterior resection for distal rectal cancer: should we make an ileostomy as a routine procedure? A prospective randomized study. Hepatogastroenterology. 2008 Sep-Oct;55(86-87):1562-7.

Reference Type BACKGROUND
PMID: 19102343 (View on PubMed)

Loffler T, Rossion I, Bruckner T, Diener MK, Koch M, von Frankenberg M, Pochhammer J, Thomusch O, Kijak T, Simon T, Mihaljevic AL, Kruger M, Stein E, Prechtl G, Hodina R, Michal W, Strunk R, Henkel K, Bunse J, Jaschke G, Politt D, Heistermann HP, Fusser M, Lange C, Stamm A, Vosschulte A, Holzer R, Partecke LI, Burdzik E, Hug HM, Luntz SP, Kieser M, Buchler MW, Weitz J; HASTA Trial Group. HAnd Suture Versus STApling for Closure of Loop Ileostomy (HASTA Trial): results of a multicenter randomized trial (DRKS00000040). Ann Surg. 2012 Nov;256(5):828-35; discussion 835-6. doi: 10.1097/SLA.0b013e318272df97.

Reference Type BACKGROUND
PMID: 23095628 (View on PubMed)

Other Identifiers

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2015/321-31/1

Identifier Type: -

Identifier Source: org_study_id

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