Effect of Anesthetic Conditions on Stapling Thickness and Quality

NCT ID: NCT04191564

Last Updated: 2019-12-09

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

20 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-03-31

Study Completion Date

2021-12-31

Brief Summary

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the excluded stomach during sleeve gastrectomy can be investigated post removal outside the patient. During stapling it is common to reduce systolic arterial blood pressure (SAP) below 100 mmHg to reduce peritoneal perfusion and have better compression. Higher intra abdominal pressures reduce also the peritoneal and mucosal perfusion and might help to improve stapling compression. Stapling compression can be evaluated by measuring stapling thickness and compare it with stomach wall thickness or by measuring leaks during leak test or better outside the patient on the excised stomach with a bursting pressure.

Detailed Description

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Patients are randomized to two groups: group standard perfusion means that the SAP is kept between 100 and 140 mmHg by adapting depth of anesthesia, by level of post expiratory pressure or by giving vasoconstriction.

low perfusion group means that

1. systolic blood pressure is kept below 100 mmHg from the first linear staple till the last by using a Clevidipine infusion to regulate the blood pressure accurate just below 100 mmHg for a short time while needed.
2. goal directed fluid therapy using 100 ml/h fluid intravenous and extra load of fluid if pulse pressure variation \> 20 %
3. increase intra abdominal pressure (IAP) up to 20 mmHg inly during stapling and return to minimum IAP needed to achieve 3 liter workspace.

The resected stomach is removed and analyzed outside the body before throwing away:

Conditions

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Gastrectomy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

low perfusion
Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

NONE

normal perfusion

Study Groups

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low perfusion

fluid restriction based on the goal directed fluid therapy is maintained during the whole case and a state of low perfusion is created by reducing the systolic blood pressure below 100 mmHg by vasoactive medications like cleviprex or nicardipine, by increasing positive end expiratory pressure (PEEP) and by a very short period of a high IAP of 20 mmHg only during firing.

Group Type EXPERIMENTAL

low perfusion state

Intervention Type PROCEDURE

reduce SAP below 100 mmHg

normal perfusion

Perfusion pressure is maintained above 100 mmHg with free fluid loading iv and the lowest IAP possible during the whole procedure.

Group Type EXPERIMENTAL

normal perfusion state

Intervention Type PROCEDURE

maintain SAP above 100 mmHg

Interventions

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low perfusion state

reduce SAP below 100 mmHg

Intervention Type PROCEDURE

normal perfusion state

maintain SAP above 100 mmHg

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* primary sleeve gastrectomy

Exclusion Criteria

* allergy to one of the drugs used intra operative
* liver, renal, cardiac or lung disease with limited function
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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AZ Sint-Jan AV

OTHER

Sponsor Role lead

Responsible Party

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Jan Mulier

Principal investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Jan Paul Mulier

Role: PRINCIPAL_INVESTIGATOR

AZSint Jan AV

Locations

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Azsintjan

Bruges, , Belgium

Site Status

Countries

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Belgium

Central Contacts

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Jan Paul Mulier, PhD

Role: CONTACT

Phone: 003259452490

Email: [email protected]

jan Mulier

Role: CONTACT

Other Identifiers

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2020RCTStaplingcondition

Identifier Type: -

Identifier Source: org_study_id