Optimization of Surgical Treatment of Patients With Incisional Ventral Hernias
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ClinicalTrials.gov Identifier: NCT05734222 |
Recruitment Status :
Recruiting
First Posted : February 17, 2023
Last Update Posted : February 17, 2023
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Tracking Information | |||||||||
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First Submitted Date ICMJE | February 8, 2023 | ||||||||
First Posted Date ICMJE | February 17, 2023 | ||||||||
Last Update Posted Date | February 17, 2023 | ||||||||
Actual Study Start Date ICMJE | September 29, 2022 | ||||||||
Estimated Primary Completion Date | April 30, 2024 (Final data collection date for primary outcome measure) | ||||||||
Current Primary Outcome Measures ICMJE |
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Original Primary Outcome Measures ICMJE | Same as current | ||||||||
Change History | No Changes Posted | ||||||||
Current Secondary Outcome Measures ICMJE |
Pus [ Time Frame: from 3 to 7 days ] development of suppuration in postoperative area
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Original Secondary Outcome Measures ICMJE | Same as current | ||||||||
Current Other Pre-specified Outcome Measures | Not Provided | ||||||||
Original Other Pre-specified Outcome Measures | Not Provided | ||||||||
Descriptive Information | |||||||||
Brief Title ICMJE | Optimization of Surgical Treatment of Patients With Incisional Ventral Hernias | ||||||||
Official Title ICMJE | Optimization of Surgical Treatment of Patients With Postoperative Median and Median-lateral Ventral Hernias | ||||||||
Brief Summary | The goal of our work of optimization of the treatment of postoperative hernias is to improve the results of treatment of patients with median and median-lateral postoperative hernias of medium (W2) and large (W3) sizes by developing new surgical techniques. The main questions it aims to answer are:
The researchers will compare an experimental group in which a new method of preparing the implant place will be used and a control group in which standard methods of treating postoperative ventral hernias were used to see whether the new method affects the improvement of the postoperative period and the reduction of complications. |
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Detailed Description | Relevance of the research topic: The problem of surgical treatment of postoperative ventral hernias (POVG) remains relevant to the present time. PWS account for 20-22% of the total number of hernias and occupy the second place in frequency of occurrence after inguinal hernias. Despite the rapid development of minimally invasive technologies in abdominal surgery, according to various authors, the frequency of occurrence of POVG after elective operations reaches 4-18.1%, and after urgent operations - 18.1-58.7% (Ishutov I.V. et al. 2020, 2018, 2016, Krivoshchekov E.P. et al. 2018, Samartsev V.A., Gavrilov V.A. 2018, 2016, Lu. Y, et al 2021). The use of mesh implants in the treatment of POVH reduced the number of relapses, but led to an increase in the frequency of postoperative wound complications, reaching, according to various authors, impressive figures - 20.9-49.2% (Ermakov N.A. et al. 2020, 2018; Greyasov V.I. et al. 2018) Complications of hernioplasty lead to an increase in postoperative beda day and an outpatient period of follow-up treatment, a sharp increase in material costs for treatment. Treatment of late complications of allogernioplasty (postoperative fistulas, mesh implant rejections) requires repeated additional hospitalizations and outpatient treatment courses (Botezatu A.A. et al., 2018, 2016; Gogia B.Sh., Alyautdinov R.R. 2018, Olsson A, et al 2021). In modern times, one of the priority areas of scientific research in herniology is the improvement of prosthetic plastics and the development of methods for the prevention of seromas, which are the most common complication of the course of the postoperative period and occur in a wide range from 0.8% to 60% (Belokonev V.I. Grachev B.D. 2018, Galimov O.V. et al. 2018, 2016, Paasch C, et al. 2021, 2019) Retromuscular plasty of the anterior abdominal wall is currently the most physiological and reliable method of surgery for hernias of median localization. Optimal methods of plastic surgery for median and lateral hernias are indicated, including in clinical recommendations, but the question of plastic surgery for ventral postoperative hernias of median-lateral localization remains open. (Clinical recommendations "Postoperative ventral hernia", 2017) Variant anatomy of vessels and nerves of the anterior abdominal wall for herniologists is important in the development of surgical techniques that minimize traumatization of neurovascular bundles during anterior abdominal wall plastic surgery. In this way, it is possible to reduce blood and lymph flow from cellular spaces, preserve the neurovascular trophic anatomical formations of the anterior abdominal wall and reduce the risk of postoperative complications. Based on the above, the development of surgical techniques that minimize traumatization of neurovascular bundles is an urgent task. The development of plastic methods for combined mid-lateral hernias is also an urgent task of modern surgery. The aim of the study: To improve the results of treatment of patients with median and median-lateral postoperative hernias of medium (W2) and large (W3) sizes by developing new surgical techniques. Research objectives:
Materials and methods of research It is planned to analyze the results of CT scans of 20 patients with Incisional ventral hernia to study the features of blood supply to the anterior abdominal wall using the Autoplan hardware software package. The experimental part It is planned to study the variant anatomy of the anterior abdominal wall on 20 unfixed corpses. To study:
Clinical part
The data obtained will be evaluated using the IBM SPSS Advanced Statistica application package. The results of the study will be generated using Word, Excel, and Microsoft Office software. In the course of the work, modern statistical research methods will be used: descriptive statistics, methods for assessing the significance of differences using parametric and nonparametric criteria, methods of correlation and variance analysis, cluster analysis, forecasting using logistic regressions. Planned scientific novelty and practical value
A brief description of the planned innovations
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Study Type ICMJE | Interventional | ||||||||
Study Phase ICMJE | Not Applicable | ||||||||
Study Design ICMJE | Allocation: Non-Randomized Intervention Model: Crossover Assignment Intervention Model Description: The study will include patients with postoperative ventral hernias of median and lateral localization and an average hernial gate width from 4.1 to 15 cm (W2-W3 according to the EHS classification).. The size of the hernial gate is determined by CT. The estimated number of patients is 60-80. 25-30 patients with median-lateral ventral postoperative hernias and 35-50 patients with median hernias are expected. 2. The control group is retrospective. It will include patients who have been operated on for POVG in the surgical department No. 1 of the KPH during the last 3 years (25-35) and 5-10 patients who will be operated on within the next 6-8 months. 3. The established group - patients who will be operated on in the surgical department No. 1 of the KPH over the next 1.5 - 2 years, using the developed techniques. Masking Description: 4. The comparison groups will include patients who underwent retromuscular plastic surgery followed by aspiration drainage of the prosthesis bed. When analyzing the results, the presence of obesity and coagulopathy will be taken into account, CT and ultrasound examination will be carried out. Special attention will be paid to the presence and volume of liquid formations in the implant bed. 5. Immediate results will be evaluated up to 1 year Criteria for evaluating immediate results: treatment time, pain syndrome, the presence of seromas and hematomas, their infection and suppuration. 6. Long-term results will be evaluated in terms from 1 to 1.5 years. Evaluation criteria: the presence of recurrent hernia, the presence of late complications - fistulas, seromas requiring drainage, pain syndrome. |
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Condition ICMJE |
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Intervention ICMJE | Procedure: A new method of repair of the abdominal wall of mid-lateral postoperative ventral hernias
Other Name: Development of techniques to minimize traumatization of the neurovascular bundles of the abdominal wall and reduce postoperative complications.
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Study Arms ICMJE |
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Publications * | Not Provided | ||||||||
* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline. |
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Recruitment Information | |||||||||
Recruitment Status ICMJE | Recruiting | ||||||||
Estimated Enrollment ICMJE |
110 | ||||||||
Original Estimated Enrollment ICMJE | Same as current | ||||||||
Estimated Study Completion Date ICMJE | May 23, 2025 | ||||||||
Estimated Primary Completion Date | April 30, 2024 (Final data collection date for primary outcome measure) | ||||||||
Eligibility Criteria ICMJE | Inclusion Criteria:
Exclusion Criteria:
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Sex/Gender ICMJE |
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Ages ICMJE | 25 Years to 88 Years (Adult, Older Adult) | ||||||||
Accepts Healthy Volunteers ICMJE | No | ||||||||
Contacts ICMJE |
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Listed Location Countries ICMJE | Russian Federation | ||||||||
Removed Location Countries | |||||||||
Administrative Information | |||||||||
NCT Number ICMJE | NCT05734222 | ||||||||
Other Study ID Numbers ICMJE | 124537 | ||||||||
Has Data Monitoring Committee | Yes | ||||||||
U.S. FDA-regulated Product |
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IPD Sharing Statement ICMJE | Not Provided | ||||||||
Current Responsible Party | Samara State Medical University | ||||||||
Original Responsible Party | Same as current | ||||||||
Current Study Sponsor ICMJE | Samara State Medical University | ||||||||
Original Study Sponsor ICMJE | Same as current | ||||||||
Collaborators ICMJE | Not Provided | ||||||||
Investigators ICMJE | Not Provided | ||||||||
PRS Account | Samara State Medical University | ||||||||
Verification Date | January 2023 | ||||||||
ICMJE Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP |