Feasibility study from a randomized controlled trial of standard closure of a stoma site vs biological mesh reinforcement
Pallan A., Patel A., Patel A., Patel A., Patel A., Lamparelli MJ., Lewis M., Subramanian K., Subramanian K., Chaudhri S., Chaudhri S., Addison S., Church R., Adedeji O., Bach S., Ford C., Cagigas C., Dimitriou N., Fallis S., Futaba K., Ismail T., Keh C., Morton D., Nepogodiev D., Nicol D., Pinkney T., Radley S., Rawstorne E., Royle TJ., Singh J., Smart C., Suggett N., Torrance A., Vohra R., Charleston P., Gilmore L., Paraoan M., Cruickshank N., Joy H., Thumbe V., Wilkin R., Gaunt A., Patel A., Williams N., Allison A., Dalton R., D'Costa C., Dennison G., Foster J., Francis N., Ockrim J., Sharma R., Varadharajan S., Hargest R., Jackson R., Rajesh A., Ogunbiyi O., Slater A., Yu L.
Aim: Hernia formation occurs at closed stoma sites in up to 30% of patients. The Reinforcement of Closure of Stoma Site (ROCSS) randomized controlled trial is evaluating whether placement of biological mesh during stoma closure safely reduces hernia rates compared with closure without mesh, without increasing surgical or wound complications. This paper aims to report recruitment, deliverability and safety from the internal feasibility study. Method: A multicentre, patient and assessor blinded, randomized controlled trial, delivered through surgical trainee research networks. A 90-patient internal feasibility study assessed recruitment, randomization, deliverability and early (30 day) safety of the novel surgical technique (ClinicalTrials.gov registration number NCT02238964). Results: The feasibility study recruited 90 patients from the 104 considered for entry (45 to mesh, 45 to no mesh). Seven of eight participating centres randomized patients within 30 days of opening. Overall, 41% of stomas were created for malignant disease and 73% were ileostomies. No mesh-specific complications occurred. Thirty-one postoperative adverse events were experienced by 31 patients, including surgical site infection (9%) and postoperative ileus (6%). One mesh was removed for re-access to the abdominal cavity, for reasons unrelated to the mesh. Independent review by the Data Monitoring and Ethics Committee of adverse event data by treatment allocation found no safety concerns. Conclusion: Multicentre randomization to this trial of biological mesh is feasible, with no early safety concerns. Progression to the full Phase III trial has continued. ROCSS shows that trainee research networks can efficiently develop and deliver complex interventional surgical trials.