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A-Part® Gel as Adhesion Prophylaxis After Major Abdominal Surgery Versus a Non-treated Group (A-PART)

Primary Purpose

Adhesions, Abdominal Cavity

Status
Completed
Phase
Phase 1
Locations
Germany
Study Type
Interventional
Intervention
A-Part® Gel
Sponsored by
Aesculap AG
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Adhesions focused on measuring randomized, controlled, single-blind study, Adhesion Prophylaxis, Abdominal Surgery, Laparotomy, median

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients of both sexes, who are candidates for a primary and elective median abdominal incision with a length of ≥ 15 cm 2.
  • Age ≥ 18 years
  • Patients who are legally capable and able to understand the nature, significance and consequences of the study and are willing and able to comply with the study protocol and the follow up
  • Written informed consent obtained according to international guidelines and local law. Informed consent will be documented by the volunteer's dated signature, which will be also signed and dated by the investigator
  • Patients with an expected survival time >12 months
  • For female adults of reproductive potential: Negative pregnancy test at visit 1 and sufficient contraception from time of written consent up to at least 4 months

Exclusion Criteria:

  • Patients with a previous median laparotomy and any other abdominal surgery (exceptions: previous laparoscopic appendectomy, cholecystectomy, inguinal hernia repair, gynecological tube sterilisation)
  • Patients with a known history of adhesions or a known history of peritonitis
  • Patients with a known sensitivity to polyvinylalcohol and/or carboxymethylcellulose
  • Simultaneous participation of the patient in another clinical trial or participation in a clinical trial within the last 30 days prior to signing the Informed consent form
  • Patients with ASA > 3 or emergency patients (including severe psychic diesease)
  • Patients with ascites > 200 ml
  • Patients with peritoneal carcinosis or peritoneal dialysis
  • Patients with a diagnosed peritonitis, intra-abdominal abscess or other intra-abdominal infection
  • Patient with renal impairment (Creatinine > 1.3 mg/dl)
  • Patients with systemic immunosuppression (e.g. hydrocortisone > 50mg daily [oral/i.v.] at any day or any equivalent dosage; other immunosuppressants like Azathioprin, Mycophenolatmofetil, Ciclosporin, Everolimus, Methotrexat, ect.), chemotherapy or radiotherapy within the last 2 weeks prior to surgery
  • Surgical procedures or patient characteristics which require insertion of more than 2 intra-abdominal drainages
  • Women within a pregnancy or breast-feeding mothers or women who wish to get pregnant within the next 4 months after surgery or women without sufficient contraceptive care

Sites / Locations

  • Chirurgische Klinik und Poliklinik - Großhadern, Klinikum der Universitaet Muenchen

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

No Intervention

Arm Label

A

B

Arm Description

A-Part® Gel

untreated control group

Outcomes

Primary Outcome Measures

Occurrence of wound healing impairment and/or postoperative peritonitis after surgery

Secondary Outcome Measures

Occurrence of anastomosis leakage after surgery
Occurrence of adverse events (AEs) and serious adverse events (SAEs) after surgery
Adhesion rates along the scar examined by ultrasound-assessment

Full Information

First Posted
March 25, 2008
Last Updated
September 8, 2015
Sponsor
Aesculap AG
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1. Study Identification

Unique Protocol Identification Number
NCT00646412
Brief Title
A-Part® Gel as Adhesion Prophylaxis After Major Abdominal Surgery Versus a Non-treated Group
Acronym
A-PART
Official Title
A Prospective, Randomised, Controlled, Single-blind Phase I-II Clinical Trial on the Safety of A-Part® Gel as Adhesion Prophylaxis After Major Abdominal Surgery Versus a Non-treated Group
Study Type
Interventional

2. Study Status

Record Verification Date
September 2015
Overall Recruitment Status
Completed
Study Start Date
July 2008 (undefined)
Primary Completion Date
May 2010 (Actual)
Study Completion Date
August 2010 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Aesculap AG

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The safety of applying A-Part® Gel intra-peritoneally under the incision in order to prevent post-surgical adhesions after median laparotomy.
Detailed Description
Primary Objective: • first assessment of the safety of applying A-Part® Gel as adhesion prophylaxis after major abdominal surgery by specific observation of two major complications of abdominal surgery (wound healing impairment, and/or postoperative peritonitis) in comparison to a control group. Secondary Objectives: To further evaluate the safety of A-Part® Gel by comparing the incidences of adverse events between the treatment groups (with special attention to anastomosis leakage) To explore the efficacy of A-Part® Gel in reducing post-surgical adhesions after median laparotomy

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Adhesions, Abdominal Cavity
Keywords
randomized, controlled, single-blind study, Adhesion Prophylaxis, Abdominal Surgery, Laparotomy, median

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
Participant
Allocation
Randomized
Enrollment
60 (Actual)

8. Arms, Groups, and Interventions

Arm Title
A
Arm Type
Experimental
Arm Description
A-Part® Gel
Arm Title
B
Arm Type
No Intervention
Arm Description
untreated control group
Intervention Type
Device
Intervention Name(s)
A-Part® Gel
Intervention Description
10 - 20 ml of A-Part® Gel will be administered before abdominal wall closure in a standardised fashion
Primary Outcome Measure Information:
Title
Occurrence of wound healing impairment and/or postoperative peritonitis after surgery
Time Frame
28 (+10) days
Secondary Outcome Measure Information:
Title
Occurrence of anastomosis leakage after surgery
Time Frame
within 28 (+10) days
Title
Occurrence of adverse events (AEs) and serious adverse events (SAEs) after surgery
Time Frame
postoperative hospital stay and up to 3 months
Title
Adhesion rates along the scar examined by ultrasound-assessment
Time Frame
14 days (range: day 7-14), 28 days (+10 days), 3 months (± 14 days)

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients of both sexes, who are candidates for a primary and elective median abdominal incision with a length of ≥ 15 cm 2. Age ≥ 18 years Patients who are legally capable and able to understand the nature, significance and consequences of the study and are willing and able to comply with the study protocol and the follow up Written informed consent obtained according to international guidelines and local law. Informed consent will be documented by the volunteer's dated signature, which will be also signed and dated by the investigator Patients with an expected survival time >12 months For female adults of reproductive potential: Negative pregnancy test at visit 1 and sufficient contraception from time of written consent up to at least 4 months Exclusion Criteria: Patients with a previous median laparotomy and any other abdominal surgery (exceptions: previous laparoscopic appendectomy, cholecystectomy, inguinal hernia repair, gynecological tube sterilisation) Patients with a known history of adhesions or a known history of peritonitis Patients with a known sensitivity to polyvinylalcohol and/or carboxymethylcellulose Simultaneous participation of the patient in another clinical trial or participation in a clinical trial within the last 30 days prior to signing the Informed consent form Patients with ASA > 3 or emergency patients (including severe psychic diesease) Patients with ascites > 200 ml Patients with peritoneal carcinosis or peritoneal dialysis Patients with a diagnosed peritonitis, intra-abdominal abscess or other intra-abdominal infection Patient with renal impairment (Creatinine > 1.3 mg/dl) Patients with systemic immunosuppression (e.g. hydrocortisone > 50mg daily [oral/i.v.] at any day or any equivalent dosage; other immunosuppressants like Azathioprin, Mycophenolatmofetil, Ciclosporin, Everolimus, Methotrexat, ect.), chemotherapy or radiotherapy within the last 2 weeks prior to surgery Surgical procedures or patient characteristics which require insertion of more than 2 intra-abdominal drainages Women within a pregnancy or breast-feeding mothers or women who wish to get pregnant within the next 4 months after surgery or women without sufficient contraceptive care
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Karl-Walter Jauch, Prof.Dr.
Organizational Affiliation
Chirurgische Klinik und Poliklinik - Großhadern, Klinikum der Universität München
Official's Role
Principal Investigator
Facility Information:
Facility Name
Chirurgische Klinik und Poliklinik - Großhadern, Klinikum der Universitaet Muenchen
City
Muenchen
State/Province
Bayern
ZIP/Postal Code
81377
Country
Germany

12. IPD Sharing Statement

Citations:
PubMed Identifier
646316
Citation
Ellis H. Wound repair. Reaction of the peritoneum to injury. Ann R Coll Surg Engl. 1978 May;60(3):219-21. No abstract available.
Results Reference
background
PubMed Identifier
11391142
Citation
Parker MC, Ellis H, Moran BJ, Thompson JN, Wilson MS, Menzies D, McGuire A, Lower AM, Hawthorn RJ, O'Briena F, Buchan S, Crowe AM. Postoperative adhesions: ten-year follow-up of 12,584 patients undergoing lower abdominal surgery. Dis Colon Rectum. 2001 Jun;44(6):822-29; discussion 829-30. doi: 10.1007/BF02234701.
Results Reference
background
PubMed Identifier
15848353
Citation
Ellis H. Intraabdominal and postoperative peritoneal adhesions. J Am Coll Surg. 2005 May;200(5):641-4. doi: 10.1016/j.jamcollsurg.2004.10.023. No abstract available.
Results Reference
background
PubMed Identifier
16232234
Citation
Parker MC, Wilson MS, Menzies D, Sunderland G, Clark DN, Knight AD, Crowe AM; Surgical and Clinical Adhesions Research (SCAR) Group. The SCAR-3 study: 5-year adhesion-related readmission risk following lower abdominal surgical procedures. Colorectal Dis. 2005 Nov;7(6):551-8. doi: 10.1111/j.1463-1318.2005.00857.x.
Results Reference
background
PubMed Identifier
15758863
Citation
Gomel V. Reproductive surgery. Minerva Ginecol. 2005 Feb;57(1):21-8.
Results Reference
background
PubMed Identifier
16320005
Citation
Fazio VW, Cohen Z, Fleshman JW, van Goor H, Bauer JJ, Wolff BG, Corman M, Beart RW Jr, Wexner SD, Becker JM, Monson JR, Kaufman HS, Beck DE, Bailey HR, Ludwig KA, Stamos MJ, Darzi A, Bleday R, Dorazio R, Madoff RD, Smith LE, Gearhart S, Lillemoe K, Gohl J. Reduction in adhesive small-bowel obstruction by Seprafilm adhesion barrier after intestinal resection. Dis Colon Rectum. 2006 Jan;49(1):1-11. doi: 10.1007/s10350-005-0268-5.
Results Reference
background
PubMed Identifier
11426591
Citation
Yamaoka T, Takahashi Y, Fujisato T, Lee CW, Tsuji T, Ohta T, Murakami A, Kimura Y. Novel adhesion prevention membrane based on a bioresorbable copoly(ester-ether) comprised of poly-L-lactide and Pluronic: in vitro and in vivo evaluations. J Biomed Mater Res. 2001 Mar 15;54(4):470-9. doi: 10.1002/1097-4636(20010315)54:43.0.co;2-x.
Results Reference
background
PubMed Identifier
11727865
Citation
Diamond MP, Freeman ML. Clinical implications of postsurgical adhesions. Hum Reprod Update. 2001 Nov-Dec;7(6):567-76. doi: 10.1093/humupd/7.6.567.
Results Reference
background
PubMed Identifier
15273541
Citation
Becker JM, Stucchi AF. Intra-abdominal adhesion prevention: are we getting any closer? Ann Surg. 2004 Aug;240(2):202-4. doi: 10.1097/01.sla.0000133118.38686.d0. No abstract available.
Results Reference
background
PubMed Identifier
7634953
Citation
Treutner KH, Bertram P, Loser S, Winkeltau G, Schumpelick V. [Prevention and therapy of intra-abdominal adhesions. A survey of 1,200 clinics in Germany]. Chirurg. 1995 Apr;66(4):398-403. German.
Results Reference
background
PubMed Identifier
9076453
Citation
Holmdahl L, Risberg B, Beck DE, Burns JW, Chegini N, diZerega GS, Ellis H. Adhesions: pathogenesis and prevention-panel discussion and summary. Eur J Surg Suppl. 1997;(577):56-62.
Results Reference
background
PubMed Identifier
10494637
Citation
Sjosten AC, Blomgren H, Larsson B, Edelstam GA. Precautions taken to prevent adhesions--a questionnaire study among Swedish obstetricians and gynaecologists. Eur J Surg. 1999 Aug;165(8):736-41. doi: 10.1080/11024159950189492.
Results Reference
background
PubMed Identifier
11317621
Citation
Trickett JP, Rainsbury RM, Green R. Paradoxical outcome after use of hyaluronate barrier to prevent intra-abdominal adhesions. J R Soc Med. 2001 Apr;94(4):183-4. doi: 10.1177/014107680109400408. No abstract available.
Results Reference
background
PubMed Identifier
17238166
Citation
Besheer A, Mader K, Kaiser S, Kressler J, Weis C, Odermatt EK. Tracking the urinary excretion of high molar mass poly(vinyl alcohol). J Biomed Mater Res B Appl Biomater. 2007 Aug;82(2):383-9. doi: 10.1002/jbm.b.30743.
Results Reference
background
PubMed Identifier
16415529
Citation
Kaneo Y, Hashihama S, Kakinoki A, Tanaka T, Nakano T, Ikeda Y. Pharmacokinetics and biodisposition of poly(vinyl alcohol) in rats and mice. Drug Metab Pharmacokinet. 2005 Dec;20(6):435-42. doi: 10.2133/dmpk.20.435.
Results Reference
background
PubMed Identifier
7616376
Citation
Yamaoka T, Tabata Y, Ikada Y. Fate of water-soluble polymers administered via different routes. J Pharm Sci. 1995 Mar;84(3):349-54. doi: 10.1002/jps.2600840316.
Results Reference
background
PubMed Identifier
7674130
Citation
Yamaoka T, Tabata Y, Ikada Y. Comparison of body distribution of poly(vinyl alcohol) with other water-soluble polymers after intravenous administration. J Pharm Pharmacol. 1995 Jun;47(6):479-86. doi: 10.1111/j.2042-7158.1995.tb05835.x.
Results Reference
background
PubMed Identifier
17109954
Citation
Ito T, Yeo Y, Highley CB, Bellas E, Benitez CA, Kohane DS. The prevention of peritoneal adhesions by in situ cross-linking hydrogels of hyaluronic acid and cellulose derivatives. Biomaterials. 2007 Feb;28(6):975-83. doi: 10.1016/j.biomaterials.2006.10.021. Epub 2006 Nov 15.
Results Reference
background
PubMed Identifier
14530667
Citation
Beck DE, Cohen Z, Fleshman JW, Kaufman HS, van Goor H, Wolff BG; Adhesion Study Group Steering Committee. A prospective, randomized, multicenter, controlled study of the safety of Seprafilm adhesion barrier in abdominopelvic surgery of the intestine. Dis Colon Rectum. 2003 Oct;46(10):1310-9. doi: 10.1007/s10350-004-6739-2.
Results Reference
background
PubMed Identifier
16969618
Citation
Salum M, Wexner SD, Nogueras JJ, Weiss E, Koruda M, Behrens K, Cohen S, Binderow S, Cohen J, Thorson A, Ternent C, Christenson M, Blatchford G, Pricolo V, Whitehead M, Doveney K, Reilly J, Glennon E, Larach S, Williamson P, Gallagher J, Ferrara A, Harford F, Fry R, Eisenstat T, Notaro J, Chinn B, Yee L, Stamos M, Cole P, Dunn G, Singh A; Program Directors Association in Colon and Rectal Surgery. Does sodium hyaluronate- and carboxymethylcellulose-based bioresorbable membrane (Seprafilm) decrease operative time for loop ileostomy closure? Tech Coloproctol. 2006 Oct;10(3):187-90; discussion 190-1. doi: 10.1007/s10151-006-0278-x. Epub 2006 Sep 20.
Results Reference
background
PubMed Identifier
16249848
Citation
Kusunoki M, Ikeuchi H, Yanagi H, Noda M, Tonouchi H, Mohri Y, Uchida K, Inoue Y, Kobayashi M, Miki C, Yamamura T. Bioresorbable hyaluronate-carboxymethylcellulose membrane (Seprafilm) in surgery for rectal carcinoma: a prospective randomized clinical trial. Surg Today. 2005;35(11):940-5. doi: 10.1007/s00595-005-3061-0.
Results Reference
background
PubMed Identifier
15264300
Citation
Weis C, Odermatt EK, Kressler J, Funke Z, Wehner T, Freytag D. Poly(vinyl alcohol) membranes for adhesion prevention. J Biomed Mater Res B Appl Biomater. 2004 Aug 15;70(2):191-202. doi: 10.1002/jbm.b.30007.
Results Reference
background
PubMed Identifier
16826328
Citation
McLeod R. Does Seprafilm really reduce adhesive small bowel obstructions? Dis Colon Rectum. 2006 Aug;49(8):1234; author reply 1235-6. doi: 10.1007/s10350-006-0621-3. No abstract available.
Results Reference
background
PubMed Identifier
16845562
Citation
Hyman NH. Justifiable conclusions? Dis Colon Rectum. 2006 Aug;49(8):1236-7; author reply 1237-8. doi: 10.1007/s10350-006-0623-1. No abstract available.
Results Reference
background
PubMed Identifier
9834393
Citation
Hadaegh A, Burns J, Burgess L, Rose R, Rowe E, LaMorte WW, Becker JM. Effects of hyaluronic acid/carboxymethylcellulose gel on bowel anastomoses in the New Zealand white rabbit. J Gastrointest Surg. 1997 Nov-Dec;1(6):569-75. doi: 10.1016/s1091-255x(97)80074-1.
Results Reference
background
PubMed Identifier
12682549
Citation
Erturk S, Yuceyar S, Temiz M, Ekci B, Sakoglu N, Balci H, Dirican A, Cengiz A, Saner H. Effects of hyaluronic acid-carboxymethylcellulose antiadhesion barrier on ischemic colonic anastomosis: an experimental study. Dis Colon Rectum. 2003 Apr;46(4):529-34. doi: 10.1007/s10350-004-6594-1.
Results Reference
background
PubMed Identifier
10753030
Citation
Schuster C, Wuthrich B, Hartmann K, Kuhn M. Anaphylaxis to E466. Allergy. 2000 Mar;55(3):303-4. doi: 10.1034/j.1398-9995.2000.00401.x. No abstract available.
Results Reference
background
PubMed Identifier
12820030
Citation
Arnaud JP, Hennekinne-Mucci S, Pessaux P, Tuech JJ, Aube C. Ultrasound detection of visceral adhesion after intraperitoneal ventral hernia treatment: a comparative study of protected versus unprotected meshes. Hernia. 2003 Jun;7(2):85-8. doi: 10.1007/s10029-003-0116-2. Epub 2003 Feb 25. Erratum In: Hernia. 2003 Sep;7(3):164.
Results Reference
background
PubMed Identifier
16630227
Citation
Karliczek A, Jesus EC, Matos D, Castro AA, Atallah AN, Wiggers T. Drainage or nondrainage in elective colorectal anastomosis: a systematic review and meta-analysis. Colorectal Dis. 2006 May;8(4):259-65. doi: 10.1111/j.1463-1318.2006.00999.x.
Results Reference
background
PubMed Identifier
15495028
Citation
Jesus EC, Karliczek A, Matos D, Castro AA, Atallah AN. Prophylactic anastomotic drainage for colorectal surgery. Cochrane Database Syst Rev. 2004 Oct 18;2004(4):CD002100. doi: 10.1002/14651858.CD002100.pub2.
Results Reference
background
PubMed Identifier
16834859
Citation
Menzies D, Pascual MH, Walz MK, Duron JJ, Tonelli F, Crowe A, Knight A; ARIEL Registry. Use of icodextrin 4% solution in the prevention of adhesion formation following general surgery: from the multicentre ARIEL Registry. Ann R Coll Surg Engl. 2006 Jul;88(4):375-82. doi: 10.1308/003588406X114730.
Results Reference
background
PubMed Identifier
17468915
Citation
Sorensen LT, Malaki A, Wille-Jorgensen P, Kallehave F, Kjaergaard J, Hemmingsen U, Moller LN, Jorgensen T. Risk factors for mortality and postoperative complications after gastrointestinal surgery. J Gastrointest Surg. 2007 Jul;11(7):903-10. doi: 10.1007/s11605-007-0165-4.
Results Reference
background
PubMed Identifier
15674882
Citation
Guenaga KF, Matos D, Castro AA, Atallah AN, Wille-Jorgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev. 2005 Jan 25;(1):CD001544. doi: 10.1002/14651858.CD001544.pub2.
Results Reference
background
PubMed Identifier
7160191
Citation
Blackwelder WC. "Proving the null hypothesis" in clinical trials. Control Clin Trials. 1982 Dec;3(4):345-53. doi: 10.1016/0197-2456(82)90024-1.
Results Reference
background
PubMed Identifier
20604918
Citation
Lang R, Baumann P, Jauch KW, Schmoor C, Weis C, Odermatt E, Knaebel HP. A prospective, randomised, controlled, double-blind phase I-II clinical trial on the safety of A-Part Gel as adhesion prophylaxis after major abdominal surgery versus non-treated group. BMC Surg. 2010 Jul 6;10:20. doi: 10.1186/1471-2482-10-20.
Results Reference
background
PubMed Identifier
26336510
Citation
Lang R, Baumann P, Schmoor C, Odermatt EK, Wente MN, Jauch KW. A-Part Gel, an adhesion prophylaxis for abdominal surgery: a randomized controlled phase I-II safety study [NCT00646412]. Ann Surg Innov Res. 2015 Sep 2;9:5. doi: 10.1186/s13022-015-0014-1. eCollection 2015.
Results Reference
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A-Part® Gel as Adhesion Prophylaxis After Major Abdominal Surgery Versus a Non-treated Group

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