Prophylactic Mesh Reinforcement for Stoma Closure

NCT ID: NCT06157645

Last Updated: 2025-12-15

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

NA

Total Enrollment

62 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-09-01

Study Completion Date

2025-09-01

Brief Summary

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In the current work we are aiming to compare between the mesh-reinforced stoma closure and the anatomical closure in terms of the risk of developing surgical site incisional hernia (SSIH),incidence of surgical site infection , post-operative Pain and Hospital stay

Detailed Description

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Intestinal stomas are used to divert intestinal content as a treatment option. Faecal flow is diverted from the site of the pathology by bringing the end or a loop of bowel through the anterior abdominal wall; any segments of the colon can be used, as well as the distal part of the ileum. A stoma may be temporary or permanent according to the condition. Temporary stomas are usually followed by elective stoma closure 6-8 weeks after. Though considered a relative safe procedure, studies reported high morbidity rates following stoma closure with different complications.

Incisional hernia following stoma closure occurs in up to 30% of patients. Incisional hernia affects quality of life, in regards to pain, physical function, ability to work, and cosmoses. Other serious complications due to bowel obstruction with incarceration or strangulation can occur which may necessitate reoperation. Mesh-reinforced stoma closure shown to decrease the incidence of surgical site incisional hernia (SSIH) with low complications risk. Though there is a debate about its efficacy due to lake of data ,and doubt to use a mesh in contaminated wounds due to fear of wounds complications which may necessitate mesh extraction or longer hospital stay make it hard for many surgeons to use Mesh-reinforced stoma closure.

In the current work we are aiming to compare between the mesh-reinforced stoma closure and the anatomical closure in terms of the risk of developing (SSIH),incidence of surgical site infection ,post-operative Pain and Hospital stay

Conditions

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Incisional Hernia Surgical Site Infection Postoperative Pain Hospital Stay, Length of Stay in Hospital From Surgery to Discharge Complication

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Participants are randomized into two parallel groups. The intervention group undergoes stoma reversal with prophylactic onlay Prolene mesh reinforcement, while the control group undergoes standard anatomical closure without mesh. Each participant receives only one assigned surgical technique, and outcomes are compared between the two groups.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

This is an open-label study. Neither the participants, the treating surgeons, nor the outcome assessors are blinded to the assigned intervention due to the surgical nature of the procedures.

Study Groups

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Group A

1. Good preparation of the patient preoperative
2. Performing an opening in the skin surrounding the stoma 3-4 mm from the muco-cutaneous junctions.
3. Separate the bowel loop away from its attachment to the abdomen wall.
4. Cut out a rim of 0.3-0.4 cm of scarred bowel edges exposes healthful tissue.
5. Avoid any spillage or soiling
6. Closing of bowel defect can be made by double layer of 3-0 vicryl interrupted.
7. Once the tissue is of poor quality for simply closing, we expand the incision in the abdomen wall and resect a section. An end-to-end anastomosis is created using the conventional 2-layers suture method.
8. Reduction of the bowel into the abdomen are carried out.
9. irrigation the surgical field with a dilute anti-biotics or antiseptics and closure of the defect by continuous sutures using vicryl or prolene sutures
10. Closure of the wound

Group Type NO_INTERVENTION

No interventions assigned to this group

Group B

1. Good preparation of the patient preoperative
2. Performing an opening in the skin surrounding the stoma 3-4 mm from the muco-cutaneous junctions.
3. Separate the bowel loop away from its attachment to the abdomen wall.
4. Cut out a rim of 0.3-0.4 cm of scarred bowel edges exposes healthful tissue.
5. Avoid any spillage or soiling
6. Closing of bowel defect can be made by double layer of 3-0 vicryl interrupted.
7. Once the tissue is of poor quality for simply closing, we expand the incision in the abdomen wall and resect a section. An end-to-end anastomosis is created using the conventional 2-layers suture method.
8. Reduction of the bowel into the abdomen are carried out.
9. irrigation the surgical field with a dilute anti-biotics or antiseptics and closure of the defect by continuous sutures using vicryl or prolene sutures
10. mesh is simply fixed over the defect as a tension-free patch (onlay)
11. Closure of the wound

Group Type EXPERIMENTAL

Prolene mesh

Intervention Type DEVICE

Application of mesh onlay post stoma closure

Interventions

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Prolene mesh

Application of mesh onlay post stoma closure

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* Patients who are fit for aesthesia.
* Patients with temporary double barrelled and simple loop ostomy
* Patients older than 16 years old

Exclusion Criteria

* Patients with end ostomy
* Infected stomas
Minimum Eligible Age

16 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Assiut University

OTHER

Sponsor Role lead

Responsible Party

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Mahmoud Abdelwahed Abdeljaber

Principal investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Mostafa Thabet, Professor

Role: STUDY_CHAIR

Assiut University

Locations

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Assiut university hospitals

Asyut, Asyut Governorate, Egypt

Site Status

Countries

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Egypt

References

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Chow A, Tilney HS, Paraskeva P, Jeyarajah S, Zacharakis E, Purkayastha S. The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6,107 cases. Int J Colorectal Dis. 2009 Jun;24(6):711-23. doi: 10.1007/s00384-009-0660-z. Epub 2009 Feb 17.

Reference Type BACKGROUND
PMID: 19221766 (View on PubMed)

Williams NS, Nasmyth DG, Jones D, Smith AH. De-functioning stomas: a prospective controlled trial comparing loop ileostomy with loop transverse colostomy. Br J Surg. 1986 Jul;73(7):566-70. doi: 10.1002/bjs.1800730717.

Reference Type BACKGROUND
PMID: 3524742 (View on PubMed)

Reinforcement of Closure of Stoma Site (ROCSS) Collaborative and the West Midlands Research Collaborative. Randomized controlled trial of standard closure of a stoma site vs biological mesh reinforcement: study protocol of the ROCSS trial. Colorectal Dis. 2018 Feb;20(2):O46-O54. doi: 10.1111/codi.13997.

Reference Type BACKGROUND
PMID: 29314655 (View on PubMed)

Mohamedahmed AYY, Stonelake S, Zaman S, Hajibandeh S. Closure of stoma site with or without prophylactic mesh reinforcement: a systematic review and meta-analysis. Int J Colorectal Dis. 2020 Aug;35(8):1477-1488. doi: 10.1007/s00384-020-03681-0. Epub 2020 Jun 25.

Reference Type BACKGROUND
PMID: 32588121 (View on PubMed)

Liu DS, Banham E, Yellapu S. Prophylactic mesh reinforcement reduces stomal site incisional hernia after ileostomy closure. World J Surg. 2013 Sep;37(9):2039-45. doi: 10.1007/s00268-013-2109-3.

Reference Type BACKGROUND
PMID: 23716028 (View on PubMed)

Lee JH, Ahn BK, Lee KH. Complications Following the Use of Biologic Mesh in Ileostomy Closure: A Retrospective, Comparative Study. Wound Manag Prev. 2020 Jun;66(6):16-22.

Reference Type BACKGROUND
PMID: 32511101 (View on PubMed)

Other Identifiers

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Mesh with stoma closur

Identifier Type: -

Identifier Source: org_study_id

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