Incisional Hernia Clinical Trial
— GIVINAOfficial title:
Giant Ventral Incisional Hernia: Characteristics of Abdominal Muscle-matrix, and Effect of Hernia Repair on Abdominal Wall Function, Respiratory Performance and Quality of Life
One of five patients undergoing open abdominal surgery develops an abdominal wall defect
(incisional hernia) as a late complication. A fraction of these are "giant" hernia with a
fascial defect beyond 10 cm. These patients are physically severely impaired, and surgical
treatment is complex.
Correction of giant incisional hernias including a relatively new and minimally invasive
technique, (endoscopic components separation) offers promising results. This procedure
allows the abdominal muscles to be joined centrally restoring the integrity of the abdominal
wall.
The treatment of patients with giant hernia is now centralized at Bispebjerg Hospital
allowing for a joint study between surgeons, pulmonologists, and sports medicine researchers
to define the functional and biophysical outcome from hernia repair. We hypothesize that the
abdominal muscle function is significantly optimized after restoration of the abdominal wall
using this technique, and that muscular function is crucial for the postoperative quality of
life. Moreover, we want to assess whether this operation specifically optimizes the function
and protein synthesis of the abdominal wall muscles, and exerts a beneficial effect on lung
function. Finally, we will investigate if the patients with giant incisional hernia may be
identified by an altered composition of their connective tissue as compared with patients
who do not develop incisional hernia.
This is a prospective study of two patient groups: 1) Patients with a giant incisional
hernia and 2) controls undergoing open surgery on other indications. Assessment is done pre-
and perioperatively and after 1 year including muscular function, lung function, abdominal
wall anatomy as provided by CT-scan, and quality of life. Specified biopsies from muscles
and connective tissue are examined for muscle fiber size/type and structure by various
methods, including electron microscopy and atomic force microscopy. Lung function is
monitored by blood gas concentrations, Chronic Obstructive Pulmonary Disease Assessment Test
questionnaire, and regular spirometry analyses. The studies are carried out by Ph.D. student
Kristian Kiim Jensen, and supervised by professor in surgery Lars Nannestad Jørgensen,
professor in sports medicine Michael Kjær and professor in pulmonary medicine Vibeke Backer.
Status | Completed |
Enrollment | 36 |
Est. completion date | March 2016 |
Est. primary completion date | March 2016 |
Accepts healthy volunteers | No |
Gender | Both |
Age group | 18 Months and older |
Eligibility |
Inclusion Criteria: - Giant ventral incisional hernia with fascial defect > 10 cm - Scheduled surgery on other indications - Provided informed consent Exclusion Criteria: - Pregnancy, - Severe heart- or lung disease - Significant musculoskeletal disease - Chemo- or radiotherapy within three months prior to the operation - Systemic corticosteroid medication |
Observational Model: Case Control, Time Perspective: Prospective
Country | Name | City | State |
---|---|---|---|
Denmark | Bispebjerg Hospital | Copenhagen NW | Copenhagen |
Lead Sponsor | Collaborator |
---|---|
Bispebjerg Hospital | University of Copenhagen |
Denmark,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Abdominal wall strength | Change in maximal abdominal wall strength measured by Good Strength system. | Preoperative and one year postoperative | No |
Secondary | Rectus abdominis muscle protein synthesis activity | The change in activity of the protein synthesis in rectus abdominis muscles of the patients. | Preoperative and one year postoperative | No |
Secondary | Change in quality of life | Changes in quality of life measured by Carolinas Comfort Scale and SF-36 | Preoperative and one year postoperative | No |
Secondary | Change in respiratory function | Change in respiratory function as measured by spirometry and maximal inspiratory and expiratory pressure. | Preoperatively, one month, and year postoperative | No |
Secondary | Maximal thigh strength | Change in maximal thigh strength as measured by Power-Rig method. | Preoperatively and one year postoperative | No |
Secondary | Rectus abdominis muscle phenotype | Changes in Rectus abdominis muscle phenotype due to hernia repair. | Preoperatively and one year postoperative | No |
Secondary | Connective tissue characteristics | Differences in connective tissue characteristics in patients with and without ventral incisional hernia. | Perioperatively | No |
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