PROphylactic Mesh to Prevent Incisional Hernias at the Former Stoma Site: the PROMISS-trial

Incisional Hernia Clinical Trial

— PROMISS  

Official title:

PROphylactic Mesh to Prevent Incisional Hernias at the Former Stoma Site: the PROMISS-trial

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT03750942
• Other study ID #: NL63259.068.17
• Status: Not yet recruiting
• Phase: N/A
• Start date: March 1, 2019
• Est. completion date: March 1, 2023

Study information

• Verified date: November 2018
• Source: Maastricht University Medical Center
• Contact: Nicole D Bouvy, MD, PhD
• Phone: +3143-3875492
• Email: n.bouvy[@]mumc.nl
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Rationale:

Approximately 7000 stomata are created in the Netherlands every year. The occurrence of a parastomal herniation is high, with a reported incidence of 4-48%. Also, the former stoma site is at increased risk for the development of an incisional hernia. A clinical incisional hernia rate of 30% is reported after stoma reversal. Herniation can cause pain, deformity and possibly incarceration, which results in a significant impact on the quality of life of the patient.

The hypothesis of this study is that the use of a prophylactic mesh at the time of stoma formation leads to a lower incidence of incisional hernias after stoma reversal, an improved quality of life and therefore a possible cost reduction in healthcare.

Objective:

To evaluate the incidence of incisional hernias after stoma reversal after preventive mesh placement compared to no mesh placement. In addition, we aim to assess the effect of preventive mesh placement on the quality of life and the effect on healthcare cost reduction by avoiding re-intervention.

Study design:

A multicentre double blind randomized controlled trial with a total follow up of 24 months.

Study population:

Adults (18-99) undergoing bowel resection with the formation of a temporary stoma.

Intervention:

A preventive mesh will be placed using a sublay keyhole technique (pre-peritoneal, retromuscular) at stoma formation. The mesh will be left in situ after stoma reversal and the hole in the mesh will be closed, to prevent incisional herniation.

Main study parameters/endpoints:

• Primary: Incidence of incisional hernias after stoma reversal

• Secondary: Quality of life, stoma related prolapse or parastomal herniation, cost effectiveness and mesh related complications.

Nature and extent of the burden and the risks associated with participation, benefit and group relatedness:

The standard surgical procedure for the treatment of parastomal hernias is used in a prophylactic fashion. As this is standard care in parastomal hernias the risks are minimal. The mesh that is used is CE approved. The burden of participation in this study is minimal for the patient all follow-up visits coincide with the regular visits for colorectal cancer. Hence, no extra outpatient department visits, and even no additional diagnostics nor other medical procedures that could potentially burden the patient, are required.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 130
• Est. completion date: March 1, 2023
• Est. primary completion date: March 1, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 99 Years

Eligibility

Inclusion Criteria:

• Age = 18 years

• Diagnosed with colorectal carcinoma

• Bowel resection following stoma formation, intended to be temporary.

• Elective surgery

• ASA-score I-III

• Signed informed consent

Exclusion Criteria:

• Emergency operation

• Peritonitis (i.e. bowel perforation)

• Bowel obstruction

• A life expectancy of less than 2 years (distant metastasis i.e. located in the liver, peritoneum, lung, cerebral or bone)

• Earlier hernia repair with mesh placed in a 10cm proximity of the future stoma site.

• Chronic use of antibiotics

• Chronic use of immunosuppressive medication

• ASA-score IV or above

• Not able to sign informed consent

• Patient being unable to speak Dutch

• Patient allergic to one of the components of the mesh

Related Conditions & MeSH terms

• Hernia
• Incisional Hernia

Intervention

Device:
• Adhesix® monofilament polypropylene mesh (Bard Davol)
The intervention group will receive preventive mesh placement and in the control group no mesh is placed, the stoma is closed according to standard practise.

Locations

Country	Name	City	State
Netherlands	Maastricht University Medical Centre	Maastricht	Limburg

Sponsors (1)

Lead Sponsor	Collaborator
Maastricht University Medical Center

Country where clinical trial is conducted

Netherlands, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Occurrence of incisional hernia at the former stoma site.	Incidence of incisional hernia Expressed in % ranging from 0-100%, a lower percentage is considered a better outcome.	24 months
Secondary	Occurrence of parastomal hernia	Incidence of parastomal hernia Expressed in % ranging from 0-100%, a lower percentage is considered a better outcome.	24 months
Secondary	Occurence of prolapse	Incidence of prolapse Expressed in % ranging from 0-100%, a lower percentage is considered a better outcome.	24 months
Secondary	Occurence of mesh infection	Incidence of mesh infection Expressed in % ranging from 0-100%, a lower percentage is considered a better outcome.	24 months
Secondary	Occurence of wound infections	Incidence of wound infections Expressed in % ranging from 0-100%, a lower percentage is considered a better outcome.	24 months
Secondary	Occurence of Seroma	Incidence of seroma Expressed in % ranging from 0-100%, a lower percentage is considered a better outcome.	24 months
Secondary	Quality of life score	Quality of life postoperatively assessed through questionnaires.; - EQ-5D-5L (0-25), lower is considered a better outcome	24 months
Secondary	Quality of life score	Quality of life postoperatively assessed through questionnaires.; - Carolina Comfort scale (0-40), lower is considered a better outcome.	24 months
Secondary	Quality of life score	Quality of life postoperatively assessed through questionnaires.; - EORTC QLQ-CR29 (0-228), lower is considered a better outcome.	24 months
Secondary	Operation length	Time from start of the operation to finish (min), longer operation time can be an indication of a more complex procedure.	during operation
Secondary	Time to stoma reversal	Time between creation of the stoma and its reversal, will be expressed in days. (minimum of 14 days to a maximum of 730 days). It will be measured from creation of stoma to reversal, which is 6 weeks on average, if the stoma is not reversed within 24 months the patient is excluded. For it will not be able to reach the primary endpoint. Delay of reversal of the stoma may indicate that patient condition or other patient related factors are not optimal.	time from stoma creation to reversal
Secondary	Cost-effectiveness	Cost benefit analysis involving health cost and societal cost due to inability to participate in work. Lower health care cost are considered a better outcome, it is hypothesised that preventive treatment results in less cost by avoiding reoperations and readmission on the long term.; Assessment will be performed using questionnaires; the iMCQ questionnaires for cost effectiveness analysis.; The questions of the questionnaire will be analysed separately, for the questions range from yes/no questions to multiple choice or questions regarding number of days/ hours worked.	24 months
Secondary	Cost-effectiveness	Cost benefit analysis involving health cost and societal cost due to inability to participate in work. Lower health care cost are considered a better outcome, it is hypothesised that preventive treatment results in less cost by avoiding reoperations and readmission on the long term.; Assessment will be performed using questionnaires; the iPCQ questionnaires for cost effectiveness analysis.; The questions of the questionnaire will be analysed separately, for the questions range from yes/no questions to multiple choice or questions regarding number of days/ hours worked.	24 months