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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT00646412
Other study ID # AAG-G-H-0602
Secondary ID
Status Completed
Phase Phase 1/Phase 2
First received March 25, 2008
Last updated September 8, 2015
Start date July 2008
Est. completion date August 2010

Study information

Verified date September 2015
Source Aesculap AG
Contact n/a
Is FDA regulated No
Health authority Germany: Federal Institute for Drugs and Medical Devices
Study type Interventional

Clinical Trial Summary

The safety of applying A-Part® Gel intra-peritoneally under the incision in order to prevent post-surgical adhesions after median laparotomy.


Description:

Primary Objective:

• first assessment of the safety of applying A-Part® Gel as adhesion prophylaxis after major abdominal surgery by specific observation of two major complications of abdominal surgery (wound healing impairment, and/or postoperative peritonitis) in comparison to a control group.

Secondary Objectives:

- To further evaluate the safety of A-Part® Gel by comparing the incidences of adverse events between the treatment groups (with special attention to anastomosis leakage)

- To explore the efficacy of A-Part® Gel in reducing post-surgical adhesions after median laparotomy


Recruitment information / eligibility

Status Completed
Enrollment 60
Est. completion date August 2010
Est. primary completion date May 2010
Accepts healthy volunteers No
Gender Both
Age group 18 Years and older
Eligibility Inclusion Criteria:

- Patients of both sexes, who are candidates for a primary and elective median abdominal incision with a length of = 15 cm 2.

- Age = 18 years

- Patients who are legally capable and able to understand the nature, significance and consequences of the study and are willing and able to comply with the study protocol and the follow up

- Written informed consent obtained according to international guidelines and local law. Informed consent will be documented by the volunteer's dated signature, which will be also signed and dated by the investigator

- Patients with an expected survival time >12 months

- For female adults of reproductive potential: Negative pregnancy test at visit 1 and sufficient contraception from time of written consent up to at least 4 months

Exclusion Criteria:

- Patients with a previous median laparotomy and any other abdominal surgery (exceptions: previous laparoscopic appendectomy, cholecystectomy, inguinal hernia repair, gynecological tube sterilisation)

- Patients with a known history of adhesions or a known history of peritonitis

- Patients with a known sensitivity to polyvinylalcohol and/or carboxymethylcellulose

- Simultaneous participation of the patient in another clinical trial or participation in a clinical trial within the last 30 days prior to signing the Informed consent form

- Patients with ASA > 3 or emergency patients (including severe psychic diesease)

- Patients with ascites > 200 ml

- Patients with peritoneal carcinosis or peritoneal dialysis

- Patients with a diagnosed peritonitis, intra-abdominal abscess or other intra-abdominal infection

- Patient with renal impairment (Creatinine > 1.3 mg/dl)

- Patients with systemic immunosuppression (e.g. hydrocortisone > 50mg daily [oral/i.v.] at any day or any equivalent dosage; other immunosuppressants like Azathioprin, Mycophenolatmofetil, Ciclosporin, Everolimus, Methotrexat, ect.), chemotherapy or radiotherapy within the last 2 weeks prior to surgery

- Surgical procedures or patient characteristics which require insertion of more than 2 intra-abdominal drainages

- Women within a pregnancy or breast-feeding mothers or women who wish to get pregnant within the next 4 months after surgery or women without sufficient contraceptive care

Study Design

Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Subject), Primary Purpose: Prevention


Related Conditions & MeSH terms


Intervention

Device:
A-Part® Gel
10 - 20 ml of A-Part® Gel will be administered before abdominal wall closure in a standardised fashion

Locations

Country Name City State
Germany Chirurgische Klinik und Poliklinik - Großhadern, Klinikum der Universitaet Muenchen Muenchen Bayern

Sponsors (1)

Lead Sponsor Collaborator
Aesculap AG

Country where clinical trial is conducted

Germany, 

References & Publications (36)

Arnaud JP, Hennekinne-Mucci S, Pessaux P, Tuech JJ, Aube C. Ultrasound detection of visceral adhesion after intraperitoneal ventral hernia treatment: a comparative study of protected versus unprotected meshes. Hernia. 2003 Jun;7(2):85-8. Epub 2003 Feb 25. Erratum in: Hernia. 2003 Sep;7(3):164. — View Citation

Beck DE, Cohen Z, Fleshman JW, Kaufman HS, van Goor H, Wolff BG; Adhesion Study Group Steering Committee. A prospective, randomized, multicenter, controlled study of the safety of Seprafilm adhesion barrier in abdominopelvic surgery of the intestine. Dis Colon Rectum. 2003 Oct;46(10):1310-9. — View Citation

Becker JM, Stucchi AF. Intra-abdominal adhesion prevention: are we getting any closer? Ann Surg. 2004 Aug;240(2):202-4. — View Citation

Besheer A, Mäder K, Kaiser S, Kressler J, Weis C, Odermatt EK. Tracking the urinary excretion of high molar mass poly(vinyl alcohol). J Biomed Mater Res B Appl Biomater. 2007 Aug;82(2):383-9. — View Citation

Blackwelder WC. "Proving the null hypothesis" in clinical trials. Control Clin Trials. 1982 Dec;3(4):345-53. — View Citation

Diamond MP, Freeman ML. Clinical implications of postsurgical adhesions. Hum Reprod Update. 2001 Nov-Dec;7(6):567-76. Review. — View Citation

Ellis H. Intraabdominal and postoperative peritoneal adhesions. J Am Coll Surg. 2005 May;200(5):641-4. — View Citation

Ellis H. Wound repair. Reaction of the peritoneum to injury. Ann R Coll Surg Engl. 1978 May;60(3):219-21. — View Citation

Erturk S, Yuceyar S, Temiz M, Ekci B, Sakoglu N, Balci H, Dirican A, Cengiz A, Saner H. Effects of hyaluronic acid-carboxymethylcellulose antiadhesion barrier on ischemic colonic anastomosis: an experimental study. Dis Colon Rectum. 2003 Apr;46(4):529-34. — View Citation

Fazio VW, Cohen Z, Fleshman JW, van Goor H, Bauer JJ, Wolff BG, Corman M, Beart RW Jr, Wexner SD, Becker JM, Monson JR, Kaufman HS, Beck DE, Bailey HR, Ludwig KA, Stamos MJ, Darzi A, Bleday R, Dorazio R, Madoff RD, Smith LE, Gearhart S, Lillemoe K, Göhl J. Reduction in adhesive small-bowel obstruction by Seprafilm adhesion barrier after intestinal resection. Dis Colon Rectum. 2006 Jan;49(1):1-11. — View Citation

Gomel V. Reproductive surgery. Minerva Ginecol. 2005 Feb;57(1):21-8. Review. — View Citation

Guenaga KF, Matos D, Castro AA, Atallah AN, Wille-Jørgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev. 2005 Jan 25;(1):CD001544. Review. Update in: Cochrane Database Syst Rev. 2009;(1):CD001544. — View Citation

Hadaegh A, Burns J, Burgess L, Rose R, Rowe E, LaMorte WW, Becker JM. Effects of hyaluronic acid/carboxymethylcellulose gel on bowel anastomoses in the New Zealand white rabbit. J Gastrointest Surg. 1997 Nov-Dec;1(6):569-75. — View Citation

Holmdahl L, Risberg B, Beck DE, Burns JW, Chegini N, diZerega GS, Ellis H. Adhesions: pathogenesis and prevention-panel discussion and summary. Eur J Surg Suppl. 1997;(577):56-62. Review. — View Citation

Hyman NH. Justifiable conclusions? Dis Colon Rectum. 2006 Aug;49(8):1236-7; author reply 1237-8. — View Citation

Ito T, Yeo Y, Highley CB, Bellas E, Benitez CA, Kohane DS. The prevention of peritoneal adhesions by in situ cross-linking hydrogels of hyaluronic acid and cellulose derivatives. Biomaterials. 2007 Feb;28(6):975-83. Epub 2006 Nov 15. — View Citation

Jesus EC, Karliczek A, Matos D, Castro AA, Atallah AN. Prophylactic anastomotic drainage for colorectal surgery. Cochrane Database Syst Rev. 2004 Oct 18;(4):CD002100. Review. — View Citation

Kaneo Y, Hashihama S, Kakinoki A, Tanaka T, Nakano T, Ikeda Y. Pharmacokinetics and biodisposition of poly(vinyl alcohol) in rats and mice. Drug Metab Pharmacokinet. 2005 Dec;20(6):435-42. — View Citation

Karliczek A, Jesus EC, Matos D, Castro AA, Atallah AN, Wiggers T. Drainage or nondrainage in elective colorectal anastomosis: a systematic review and meta-analysis. Colorectal Dis. 2006 May;8(4):259-65. Review. — View Citation

Kusunoki M, Ikeuchi H, Yanagi H, Noda M, Tonouchi H, Mohri Y, Uchida K, Inoue Y, Kobayashi M, Miki C, Yamamura T. Bioresorbable hyaluronate-carboxymethylcellulose membrane (Seprafilm) in surgery for rectal carcinoma: a prospective randomized clinical trial. Surg Today. 2005;35(11):940-5. — View Citation

Lang R, Baumann P, Jauch KW, Schmoor C, Weis C, Odermatt E, Knaebel HP. A prospective, randomised, controlled, double-blind phase I-II clinical trial on the safety of A-Part Gel as adhesion prophylaxis after major abdominal surgery versus non-treated group. BMC Surg. 2010 Jul 6;10:20. doi: 10.1186/1471-2482-10-20. — View Citation

Lang R, Baumann P, Schmoor C, Odermatt EK, Wente MN, Jauch KW. A-Part Gel, an adhesion prophylaxis for abdominal surgery: a randomized controlled phase I-II safety study [NCT00646412]. Ann Surg Innov Res. 2015 Sep 2;9:5. doi: 10.1186/s13022-015-0014-1. eC — View Citation

McLeod R. Does Seprafilm really reduce adhesive small bowel obstructions? Dis Colon Rectum. 2006 Aug;49(8):1234; author reply 1235-6. — View Citation

Menzies D, Pascual MH, Walz MK, Duron JJ, Tonelli F, Crowe A, Knight A; ARIEL Registry. Use of icodextrin 4% solution in the prevention of adhesion formation following general surgery: from the multicentre ARIEL Registry. Ann R Coll Surg Engl. 2006 Jul;88(4):375-82. — View Citation

Parker MC, Ellis H, Moran BJ, Thompson JN, Wilson MS, Menzies D, McGuire A, Lower AM, Hawthorn RJ, O'Briena F, Buchan S, Crowe AM. Postoperative adhesions: ten-year follow-up of 12,584 patients undergoing lower abdominal surgery. Dis Colon Rectum. 2001 Jun;44(6):822-29; discussion 829-30. — View Citation

Parker MC, Wilson MS, Menzies D, Sunderland G, Clark DN, Knight AD, Crowe AM; Surgical and Clinical Adhesions Research (SCAR) Group. The SCAR-3 study: 5-year adhesion-related readmission risk following lower abdominal surgical procedures. Colorectal Dis. 2005 Nov;7(6):551-8. — View Citation

Salum M, Wexner SD, Nogueras JJ, Weiss E, Koruda M, Behrens K, Cohen S, Binderow S, Cohen J, Thorson A, Ternent C, Christenson M, Blatchford G, Pricolo V, Whitehead M, Doveney K, Reilly J, Glennon E, Larach S, Williamson P, Gallagher J, Ferrara A, Harford F, Fry R, Eisenstat T, Notaro J, Chinn B, Yee L, Stamos M, Cole P, Dunn G, Singh A; Program Directors Association in Colon and Rectal Surgery. Does sodium hyaluronate- and carboxymethylcellulose-based bioresorbable membrane (Seprafilm) decrease operative time for loop ileostomy closure? Tech Coloproctol. 2006 Oct;10(3):187-90; discussion 190-1. Epub 2006 Sep 20. — View Citation

Schuster C, Wüthrich B, Hartmann K, Kuhn M. Anaphylaxis to E466. Allergy. 2000 Mar;55(3):303-4. — View Citation

Sjösten AC, Blomgren H, Larsson B, Edelstam GA. Precautions taken to prevent adhesions--a questionnaire study among Swedish obstetricians and gynaecologists. Eur J Surg. 1999 Aug;165(8):736-41. — View Citation

Sørensen LT, Malaki A, Wille-Jørgensen P, Kallehave F, Kjaergaard J, Hemmingsen U, Møller LN, Jørgensen T. Risk factors for mortality and postoperative complications after gastrointestinal surgery. J Gastrointest Surg. 2007 Jul;11(7):903-10. — View Citation

Treutner KH, Bertram P, Löser S, Winkeltau G, Schumpelick V. [Prevention and therapy of intra-abdominal adhesions. A survey of 1,200 clinics in Germany]. Chirurg. 1995 Apr;66(4):398-403. German. — View Citation

Trickett JP, Rainsbury RM, Green R. Paradoxical outcome after use of hyaluronate barrier to prevent intra-abdominal adhesions. J R Soc Med. 2001 Apr;94(4):183-4. — View Citation

Weis C, Odermatt EK, Kressler J, Funke Z, Wehner T, Freytag D. Poly(vinyl alcohol) membranes for adhesion prevention. J Biomed Mater Res B Appl Biomater. 2004 Aug 15;70(2):191-202. — View Citation

Yamaoka T, Tabata Y, Ikada Y. Comparison of body distribution of poly(vinyl alcohol) with other water-soluble polymers after intravenous administration. J Pharm Pharmacol. 1995 Jun;47(6):479-86. — View Citation

Yamaoka T, Tabata Y, Ikada Y. Fate of water-soluble polymers administered via different routes. J Pharm Sci. 1995 Mar;84(3):349-54. — View Citation

Yamaoka T, Takahashi Y, Fujisato T, Lee CW, Tsuji T, Ohta T, Murakami A, Kimura Y. Novel adhesion prevention membrane based on a bioresorbable copoly(ester-ether) comprised of poly-L-lactide and Pluronic: in vitro and in vivo evaluations. J Biomed Mater Res. 2001 Mar 15;54(4):470-9. — View Citation

* Note: There are 36 references in allClick here to view all references

Outcome

Type Measure Description Time frame Safety issue
Primary Occurrence of wound healing impairment and/or postoperative peritonitis after surgery 28 (+10) days Yes
Secondary Occurrence of anastomosis leakage after surgery within 28 (+10) days Yes
Secondary Occurrence of adverse events (AEs) and serious adverse events (SAEs) after surgery postoperative hospital stay and up to 3 months Yes
Secondary Adhesion rates along the scar examined by ultrasound-assessment 14 days (range: day 7-14), 28 days (+10 days), 3 months (± 14 days) No
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