- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT00761475
Primary Mesh Closure of Abdominal Midline Wounds (PRIMA)
October 27, 2016 updated by: hasan eker, Erasmus Medical Center
Primary Mesh Closure of Abdominal Midline Wounds; a Prospective Randomized Multicenter Trial
Incisional hernia is the most frequently seen long term complication in surgery causing much morbidity and even mortality in patients.
Despite studies on the optimal closing technique for laparotomies, the risk for incisional hernia after midline incision remains about 5-20 %.
Major risk factors for incisional hernia after a laparotomy, like obesity, steroid use, malnutrition, smoking and connective tissue disorders, are known.
Despite this knowledge, there has not yet been developed a sufficient method for prevention.
One specific group of high risk patients are patients with an abdominal aortic aneurysm (AAA).
The relationship between aortic aneurysm and other abdominal wall hernias, like inguinal hernias, has been reported.
Retrospective and prospective studies have shown an average risk for incisional hernia after AAA repair of 31.6 %.
Another high risk group is the group of obese patients.
Patients with a BMI of more than 27 have a high risk of developing an incisional hernia after midline incision with an incidence of 22% after 12 months.
Considering only 50 % of incisional hernia will be clinically evident in the first 12 months, the total incidence will be above 30%.
This high risk group of patients with obesitas and aneurysmatic disease can benefit most from prevention.
Some small studies have been performed to evaluate the usefulness and safety of primary laparotomy wound closure with the aid of prosthetic mesh.
These studies show a very low risk for incisional hernias and a low infection rate, even when used in contaminated wounds such as colostomal surgery.
However, there has not been performed an adequate randomized controlled trial to study the prevention of incisional hernias.
Our hypothesis is that incisional hernia prevention with use of prosthetic mesh after laparotomy is effective in patients with aortic aneurysm and in obese patients with a BMI of more than 27.
Study Overview
Status
Completed
Conditions
Intervention / Treatment
Study Type
Interventional
Enrollment (Actual)
480
Phase
- Phase 3
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Locations
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Vienna, Austria
- Wilhelminenspital
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Berlin, Germany
- Berlin-Charite Universitatsklinikum
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Hamburg, Germany
- Hamburg-Eppefdorf Universitatsklinikum
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Heidelberg, Germany
- Heidelberg University Medical Center
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Munchen, Germany
- Munchen University Medical Center
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Capelle a/d IJssel, Netherlands
- IJsselland ziekenhuis
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Emmen, Netherlands
- Scheper Ziekenhuis
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Rotterdam, Netherlands
- Maasstad Ziekenhuis
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Rotterdam, Netherlands
- Sint Franciscus Gasthuis
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Veldhoven, Netherlands
- Maxima Medisch Centrum
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Zwolle, Netherlands
- Isala Klinieken
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Zuid-Holland
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Rotterdam, Zuid-Holland, Netherlands, 3015 CE
- Erasmus Medical Center
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Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- Every elective midline laparotomy for patients with Abdominal Aortic Aneurysm and patients with a BMI of more than 27.
- Signed informed consent
Exclusion Criteria:
- Age < 18 years
- Emergency procedure
- Inclusion in other trials
- Aortic reconstruction for obstructive disease
- Life expectancy less than 24 months
- Pregnant women
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Triple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
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Placebo Comparator: 1
primary closure of the midline
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primary closure of the midline
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Active Comparator: 2
onlay mesh supported closure
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onlay mesh supported closure midline laparotomy
sublay mesh supported closure midline laparotomy
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Active Comparator: 3
sublay mesh supported closure
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onlay mesh supported closure midline laparotomy
sublay mesh supported closure midline laparotomy
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
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incisional hernia occurence
Time Frame: 2 years
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2 years
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Secondary Outcome Measures
Outcome Measure |
Time Frame |
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quality of life
Time Frame: 2 years
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2 years
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complications
Time Frame: 1 month
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1 month
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post-operative pain
Time Frame: 1 month
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1 month
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Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
General Publications
- Jairam AP, Timmermans L, Eker HH, Pierik REGJM, van Klaveren D, Steyerberg EW, Timman R, van der Ham AC, Dawson I, Charbon JA, Schuhmacher C, Mihaljevic A, Izbicki JR, Fikatas P, Knebel P, Fortelny RH, Kleinrensink GJ, Lange JF, Jeekel HJ; PRIMA Trialist Group. Prevention of incisional hernia with prophylactic onlay and sublay mesh reinforcement versus primary suture only in midline laparotomies (PRIMA): 2-year follow-up of a multicentre, double-blind, randomised controlled trial. Lancet. 2017 Aug 5;390(10094):567-576. doi: 10.1016/S0140-6736(17)31332-6. Epub 2017 Jun 20. Erratum In: Lancet. 2017 Aug 5;390(10094):554.
- Timmermans L, Eker HH, Steyerberg EW, Jairam A, de Jong D, Pierik EG, Lases SS, van der Ham AC, Dawson I, Charbon J, Schuhmacher C, Izbicki JR, Neuhaus P, Knebel P, Fortelny R, Kleinrensink GJ, Jeekel J, Lange JF. Short-term results of a randomized controlled trial comparing primary suture with primary glued mesh augmentation to prevent incisional hernia. Ann Surg. 2015 Feb;261(2):276-81. doi: 10.1097/SLA.0000000000000798.
- Nieuwenhuizen J, Eker HH, Timmermans L, Hop WC, Kleinrensink GJ, Jeekel J, Lange JF; PRIMA Trialist Group. A double blind randomized controlled trial comparing primary suture closure with mesh augmented closure to reduce incisional hernia incidence. BMC Surg. 2013 Oct 28;13:48. doi: 10.1186/1471-2482-13-48.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start
February 1, 2009
Primary Completion (Actual)
December 1, 2012
Study Completion (Actual)
April 1, 2015
Study Registration Dates
First Submitted
September 26, 2008
First Submitted That Met QC Criteria
September 26, 2008
First Posted (Estimate)
September 29, 2008
Study Record Updates
Last Update Posted (Estimate)
October 28, 2016
Last Update Submitted That Met QC Criteria
October 27, 2016
Last Verified
October 1, 2016
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- PRIMA TRIAL
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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