Preoperative Weight Loss for Open Abdominal Wall Reconstruction
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ClinicalTrials.gov Identifier: NCT05925959 |
Recruitment Status :
Recruiting
First Posted : June 29, 2023
Last Update Posted : September 21, 2023
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Condition or disease | Intervention/treatment | Phase |
---|---|---|
Abdominal Wall Hernia | Other: Preoperative Weight Management Program | Not Applicable |
Study Type : | Interventional (Clinical Trial) |
Estimated Enrollment : | 258 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | Single (Outcomes Assessor) |
Masking Description: | The assessor of the patient reported outcomes will be blinded. Hernia recurrence will be assessed by blinded review of CT scans by 3 surgeons. |
Primary Purpose: | Treatment |
Official Title: | Preoperative Weight Loss for Open Abdominal Wall Reconstruction |
Actual Study Start Date : | June 19, 2023 |
Estimated Primary Completion Date : | June 1, 2027 |
Estimated Study Completion Date : | June 1, 2027 |
Arm | Intervention/treatment |
---|---|
No Intervention: Upfront Surgery | |
Active Comparator: Preoperative Weight Management Program |
Other: Preoperative Weight Management Program
The medical obesity intervention is comprised of monthly visits with an obesity medicine (OM) provider +/- a registered dietitian (in person or virtual). Lifestyle modifications (nutrition, physical activity, stress, sleep), appetite control, and medication side effects will be addressed in all visits. At initial visit, patients will evaluated in person by an OM provider +/- registered dietitian. An individualized intense lifestyle intervention will be implemented with the addition of an anti-obesity medication (phentermine, naltrexone/bupropion, phentermine/topiramate, liraglutide, semaglutide, etc). Medication use will be based on disease risk, patient preference, severity of obesity, contraindications, potential drug interactions and insurance coverage. A diet recommendation will be tailored to the patient's medical and food allergy history. Weight and vital signs will be monitored at each visit. Participants will have a total of 5 follow-up monthly encounters, every 30 +/- 7 days. |
- Abdominal core health-specific quality of life at 1 year [ Time Frame: 1 year ]This will be measured at 1 year using the HerQLes survey which is scored from 0-100 with higher scores indicating better quality of life.
- Hernia recurrence at 1 year [ Time Frame: 1 year ]This will be based on based on the current consensus definition of hernia recurrence which considers CT scan reviewed by 3 blinded assessors, surgeon clinical exam, and patient-reported bulge.
- Wound morbidity at 30 days [ Time Frame: 30 days ]This includes including surgical site infection, surgical site occurrence, and surgical site occurrence requiring procedural intervention.
- Wound morbidity at 1 year [ Time Frame: 1 year ]This includes including surgical site infection, surgical site occurrence, and surgical site occurrence requiring procedural intervention.
- Body composition changes in weight [ Time Frame: 1 year ]This includes comparative mean changes in body weight (kg) between groups from time of enrollment, day of surgery, 30-day follow-up, and 1-year follow-up.
- Body composition changes in BMI [ Time Frame: 1 year ]This includes comparative mean changes in BMI (kg/m2) between groups from time of enrollment, day of surgery, 30-day follow-up, and 1-year follow-up.
- Patient abdominal wall specific- quality of life with preoperative weight management program [ Time Frame: 1 year ]This includes difference in abdominal wall-specific quality of life using the HerQLes score (0-100 with higher scores indicating better abdominal wall-specific quality of life) in the weight loss arm before and after weight loss intervention.
- Patient-reported pain changes with preoperative weight management program [ Time Frame: 1 year ]This includes difference in pain using the PROMIS 3a Pain Intensity Score (30.7-71.8 with higher scores indicating more pain) in the weight loss arm before and after weight loss intervention.
- Patient-reported quality of life changes with preoperative weight management program [ Time Frame: 1 year ]This includes difference in overall quality of life using the EQ5D-5L with VAS (scored with an index value and a 0-100 score with higher scores indicating better quality of life) in the weight loss arm before and after weight loss intervention.
- Abdominal wall -specific quality of life short-term [ Time Frame: 30 days ]This includes difference in abdominal wall -specific quality of life using the HerQLes score between groups at baseline and 30 days postoperatively.
- Pain scores [ Time Frame: 1 year ]This includes the difference in pain scores using the PROMIS 3a Pain Intensity Score (scored from 30.7-71.8) at baseline, 30-day, and 1 year.
- Cost effective analysis [ Time Frame: 1 year ]Perform a formal cost effectiveness analysis.
- Body weight percentage loss [ Time Frame: 1 year ]Proportion of patients achieving a reduction in 5% and 10% body weight at end of 6-month medical weight loss intervention, day of surgery, and 1-year follow-up
- Weight management program adherence [ Time Frame: 1 year ]Proportion of successful completion of the program (defined as attending at least 4 visits) is associated with lower wound complications, hernia recurrence, or higher HerQLes score at one year
- Impact of 10% body weight loss on wound complications [ Time Frame: 1 year ]For patients with weight loss of 10% body weight prior to surgery compared to no weight loss prior to surgery - compare proportion of wound complications
- Impact of 10% body weight loss on hernia recurrence [ Time Frame: 1 year ]For patients with weight loss of 10% body weight prior to surgery compared to no weight loss prior to surgery - compare hernia recurrence at one year
- Impact of 10% body weight loss [ Time Frame: 1 year ]For patients with weight loss of 10% body weight prior to surgery compared to no weight loss prior to surgery - compare HerQLes score (0-100 with higher scores indicating better abdominal wall specific- quality of life) at one year
- Urgent repair [ Time Frame: 1 year ]Number of patients who require urgent hernia repair in either arm
- Bariatric surgery prior to hernia repair and wounds [ Time Frame: 1 year ]Number of patients who opt for bariatric surgery and, for those patients that undergo hernia repair, to evaluate rates of wound complications at one year
- Bariatric surgery prior to hernia repair and hernia recurrence [ Time Frame: 1 year ]Number of patients who opt for bariatric surgery and, for those patients that undergo hernia repair, to evaluate rates of hernia recurrence at one year
- Bariatric surgery prior to hernia repair and abdominal wall specific quality of life [ Time Frame: 1 year ]Number of patients who opt for bariatric surgery and, for those patients that undergo hernia repair and HerQLes scores (0-100 with higher scores indicating better abdominal wall specific- quality of life) at one year
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Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | Yes |
Inclusion criteria
- Adults having open retromuscular ventral hernia repair with an anticipated posterior component separation with transversus abdominis release and synthetic mesh
- BMI 40-55 kg/m2 and who are not planning to pursue weight loss surgery for any of the following reasons: they are not a candidate for weight loss surgery, cannot pursue weight loss surgery for insurance reasons, or are not interested in pursuing weight loss surgery.
Exclusion criteria
- Lack of English language fluency
- Urgent need for repair as determined by surgeon judgement
- Pregnant patients
- Permanent stoma in place
- Isolated flank hernia
- Anticipated need for staged operation; for example, patients who will undergo a mesh excision separate from definitive reconstruction.
- BMI <40 or >55 kg/m2
- Inability to participate in the Obesity Management Program due to lack of insurance coverage or history of mental illness (including eating disorders, schizophrenia, etc.).
- Obstructive symptoms
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT05925959
Contact: Benjamin T Miller, MD | 216 406-8573 | millerb35@ccf.org | |
Contact: Daphne Remulla, MD | 216 399-7047 | REMULLD@ccf.org |
United States, Ohio | |
Cleveland Clinic Main Campus | Recruiting |
Cleveland, Ohio, United States, 44195 | |
Contact: Sara Maskal, MD 216-870-5655 MASKALS2@ccf.org |
Principal Investigator: | Benjamin T Miller, MD | The Cleveland Clinic |
Responsible Party: | Benjamin T. Miller, Assistant Professor, The Cleveland Clinic |
ClinicalTrials.gov Identifier: | NCT05925959 |
Other Study ID Numbers: |
23-418 |
First Posted: | June 29, 2023 Key Record Dates |
Last Update Posted: | September 21, 2023 |
Last Verified: | September 2023 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | No |
Studies a U.S. FDA-regulated Drug Product: | No |
Studies a U.S. FDA-regulated Device Product: | No |
Weight Loss Hernia, Abdominal Hernia, Ventral Internal Hernia |
Body Weight Changes Body Weight Hernia Pathological Conditions, Anatomical |