- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05528107
Laparoscopic IPOM Plus vs. eTEP Trial
Comparison of Laparoscopic Intraperitoneal Onlay Mesh (IPOM Plus) and Extended Totally Extraperitoneal (eTEP) Repair for Incisional Hernia - a Randomized Controlled Trial
The survey will compare primary and secondary outcomes of laparoscopic intraperitoneal onlay mesh (IPOM plus) and extended totally extraperitoneal (eTEP) repair for incisional hernia.
The research hypothesis is the following: patients who underwent eTEP repair may experience 30% less pain, assessed on the NRS-11 scale by the end of postoperative day 1, compared with IPOM plus procedure
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The use of minimally invasive surgery for the treatment of patients with incisional ventral hernias has significant advantages over open surgery. According to the current guidelines, the optimal technique for IPOM repair is a combination of suturing hernia defect and implantation an intraperitoneal anti-adhesive coated mesh prosthesis - the so-called "IPOM plus" technology (R.Bittner et al., 2019). The development of laparoscopic surgery has led to the new minimally invasive technique for ventral hernia repair - extended-view totally extraperitoneal plasty (eTEP) (I. Belyansky et al., 2018). An important advantage of eTEP is the non-fixation technique of implant placement due to correct positioning compared to the need for combined fixation for IPOM or IPOM plus, which probably affects on the level of postoperative pain in the early postoperative period.
The results of the first RCT comparing IPOM and eTEP ventral hernia repair were recently published (Mayank J. et al., 2022). It was demonstrated the benefits of eTEP repair in several aspects: less pain in the early postoperative period, as well as a faster return to physical activity and lower intervention costs. However, a significant limitation of this RCT is the analysis of interventions in a mixed group of patients with primary ventral and incisional hernias, as well as the use of IPOM procedure without suturing the hernia defect.
The sample size was determined based on the above hypothesis regarding the primary point of the study. Considering trial of Asencio F. et al. (2009) in a group of patients with incisional ventral hernias, the level of pain at the end of the first postoperative day after IPOM repair was 4.76 according to the VAS (visual analog scale) with a standard deviation of 1.975. Assuming α (type I error rate) 0.05, β 0.20, it would need a total sample size of 60 patients. Taking into account the probability of loss of patients in the evaluation of long-term results up to 20%, 72 patients will be required (36 patients per group).
Taking into account the inconsistency of the literature data on the level of pain in the early postoperative period after IPOM procedure for incisional ventral hernia repair, as well as the established primary point of the study, the investigators plan an additional calculation with correction of the sample size after evaluation intermediate results upon reaching 50% of enrolled patients of the initially established.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Alexander Sazhin, professor
- Phone Number: +79163904180
- Email: sazhin-av@yandex.ru
Study Contact Backup
- Name: Georgy Ivakhov, PhD
- Phone Number: +79262844224
- Email: ivakhovsurg@yandex.ru
Study Locations
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Moscow, Russian Federation
- Recruiting
- Clinical City Hospital #1 named after N.I. Pirogov
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Contact:
- Georgy Ivakhov, Prof
- Phone Number: +79264578568
- Email: ivakhovsurg@gmail.com
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- midline incisional hernia
- defect width 2-6 cm
- ASA I-II class
- Elective hernia repair
- Considered eligible for minimally invasive ventral hernia repair
- Able to give informed consent
- Able to tolerate general anesthesia
Exclusion Criteria:
- primary ventral herna
- lateral hernia with/without midline
- defect width more than 6 cm
- refuse to give informed consent
- prior mesh placement in the retrorectus space
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Laparoscopic Intraperitoneal Onlay Mesh plus ventral hernia repair
Laparoscopic Intraperitoneal Onlay Mesh plus repair will be used to perform a minimally invasive ventral hernia repair with intraperitoneal mesh placement and suturing hernia defect.
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Participants will undergo Lap IPOM plus repair according to the assigned treatment arm.
Other Names:
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Active Comparator: Extended-view totally extraperitoneal ventral hernia repair
Extended-view totally extraperitoneal ventral hernia repair will be used to perform minimally invasive ventral hernia repair with retrorectus mesh placement
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Participants will undergo eTEP repair according to the assigned treatment arm.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
pain on postoperative day 1
Time Frame: postoperative day 1
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Pain score will be assessed using the Numeric Pain Rating Scale. The mean pain score is calculated between pain values at rest and on coughing. Participants verbally requested to rate their pain : "Rate your pain from 0 (no pain) to 10 (unbearable pain)". 0 point is the minimum and 10 point is the maximum. The higher the score, the more severe the pain. |
postoperative day 1
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
pain on postoperative days 7 and 30
Time Frame: postoperative 7 (±1) and 30 (±3) days
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Pain score will be assessed using the Numeric Pain Rating Scale. The mean pain score is calculated between pain values at rest and on physical activity. Participants verbally requested to rate their pain : "Rate your pain from 0 (no pain) to 10 (unbearable pain)". 0 point is the minimum and 10 point is the maximum. The higher the score, the more severe the pain. |
postoperative 7 (±1) and 30 (±3) days
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length of stay
Time Frame: 30 days after surgery
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From date of hospital admission until discharge.
The length of hospital stay (days)
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30 days after surgery
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analgetic consumption
Time Frame: 48 hours after surgery
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Consumption of analgesics during the first 48 hours after surgery
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48 hours after surgery
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number of participants with chronic pain
Time Frame: postoperative day 100 (±5 days)
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Persisted pain in surgical site more than 90 days after surgery.
Pain score will be assessed using the Numeric Pain Rating Scale.
Participants verbally requested to rate their pain : "Rate your pain from 0 (no pain) to 10 (unbearable pain)".
0 point is the minimum and 10 point is the maximum.
The higher the score, the more severe the pain.
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postoperative day 100 (±5 days)
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postoperative complications
Time Frame: 30 days after surgery
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Number of participants with postoperative complications, evaluated by Clavien-Dindo classification of surgical complications from Dindo et al.
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30 days after surgery
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pain 6 hours after surgery
Time Frame: 6 hours (± 1 hour) after surgery
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Pain score will be assessed using the Numeric Pain Rating Scale. The mean pain score is calculated between pain values at rest and on coughing. Participants verbally requested to rate their pain : "Rate your pain from 0 (no pain) to 10 (unbearable pain)". 0 point is the minimum and 10 point is the maximum. The higher the score, the more severe the pain. |
6 hours (± 1 hour) after surgery
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Collaborators and Investigators
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2907-1/22
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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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