Operative Correction of Rectus Muscle Diastasis (ARD): the Effect on Low Back Pain and Movement Control

NCT ID: NCT03509376

Last Updated: 2018-04-26

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

UNKNOWN

Clinical Phase

NA

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-04-01

Study Completion Date

2021-12-31

Brief Summary

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This study is a randomized controlled trial comparing two ADR repair methods: nylon suturing and nylon suture with mesh enforcement. The ADR correction is performed simultaneously with abdominoplasty/ modified skin reduction abdominoplasty.

Detailed Description

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Abdominal diastasis recti (ADR) persists after pregnancies in one third of women. Traditionally plain ADR has been managed conservatively. There is some evidence that ADR reduces abdominal integrity and functional strength, contributing to pelvic instability and back pain. However, patients are referred to a surgeon mainly because of some other primary concern and ADR is an additional condition: in the case of excess skin-subcutis, the person is referred to a plastic and reconstructive surgeon for abdominoplasty and in the case of midline hernia, to a general surgeon.

In combination with abdominoplasty the plication of the superficial aponeurosis of recti muscles is the most commonly used reconstructive technique. There is a wide variety of different plication procedures available. Convincing data of the long-term results of ADR repair are lacking especially when ADR is severe. Some studies have reported large recurrence rates. Polypropylene mesh repair is an evidence-based technique to ensure a strong and reliable abdominal wall repair in ventral hernias or in high risk laparotomy wounds. Large retromuscular or intraperitoneal meshes have been used also in ARD repair.

This study reports a novel surgical technique aimed at reliable and mini-invasive open repair of ADR with or without midline hernia combined by abdominoplasty for symptomatic ADR patients. In RmB (roll mesh in between) method the investigators bury a narrow piece of self-gripping mesh inside the plicated linea alba to give tensile strength to plication. Patients are randomized to a suture plication group or RmB group.

Outcome evaluation is performed by clinical examination with video recorded movement control tests and with structured questionnaires for Quality of Life (RAND36) and for low back pain (LBP) (Oswestry 2.0). Evaluation is done three times: when recruiting the patient, after a conservative 3-6 months therapy with written instructions and one year after the intervention. Complications and recurrences are recorded as well.

Outcomes The effect of ADR repair on LBP and movement control problems Patient satisfaction and complications of ADR repair after the two techniques

Conditions

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Diastasis Recti

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Patients are randomised to a suture repair or suture with mesh repair
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
The physiotherapist doing the clinical examinations at different phases of the study

Study Groups

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Suture repair

Diastasis recti is repaired using nylon suture for the plication

Group Type EXPERIMENTAL

Suture repair

Intervention Type PROCEDURE

The diastasis is repaired with continous nylon suture

Rolled mesh repair

Diastasis recti is repaired with self gripping mesh to reinforce the suture line

Group Type EXPERIMENTAL

Rolled mesh repair

Intervention Type PROCEDURE

Continuous nylon suture is done over a narrow strip of self gripping Rolled mesh to repair the diastasis

Interventions

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Suture repair

The diastasis is repaired with continous nylon suture

Intervention Type PROCEDURE

Rolled mesh repair

Continuous nylon suture is done over a narrow strip of self gripping Rolled mesh to repair the diastasis

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Symptomatic diastasis recti (\> 3 cm) after pregnancies, with or without a midline hernia

Exclusion Criteria

* BMI \> 28,
* smoking
* less than a year since the previous pregnancy or still breast feeding
* planning further pregnancies
Minimum Eligible Age

18 Years

Maximum Eligible Age

60 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Oulu University Hospital

OTHER

Sponsor Role collaborator

Helsinki University Central Hospital

OTHER

Sponsor Role lead

Responsible Party

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Jaana Vironen

Chief surgeon

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Tiina Jahkola

Role: PRINCIPAL_INVESTIGATOR

Helsinki University Central Hospital

Tero Rautio

Role: PRINCIPAL_INVESTIGATOR

Oulu University Hospital

Katariina Kilpivaara

Role: PRINCIPAL_INVESTIGATOR

Oulu University Hospital

Locations

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HUCH Jorvi Hospital, department of Surgery

Espoo, , Finland

Site Status RECRUITING

Oulu University Hospital

Oulu, , Finland

Site Status RECRUITING

Countries

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Finland

Central Contacts

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Jaana Vironen

Role: CONTACT

+358504422892

Reetta Tuominen

Role: CONTACT

Facility Contacts

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Jaana Vironen, MD PhD

Role: primary

+358 50 4422892

Tero Rautio

Role: primary

Other Identifiers

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HUS/26/2018

Identifier Type: -

Identifier Source: org_study_id

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