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Randomized Controlled Trial
. 2014 May 22:14:33.
doi: 10.1186/1471-2482-14-33.

Mesh Or Patch for Hernia on Epigastric and Umbilical Sites (MORPHEUS trial): study protocol for a multi-centre patient blinded randomized controlled trial

Jeroen E H Ponten  1 , Bart J M Leenders, Jan A Charbon, Tanja Lettinga-van de Poll, Jeroen Heemskerk, Ingrid S Martijnse, Joop L M Konsten, Simon W Nienhuijs
Affiliations
Randomized Controlled Trial

Mesh Or Patch for Hernia on Epigastric and Umbilical Sites (MORPHEUS trial): study protocol for a multi-centre patient blinded randomized controlled trial

Jeroen E H Ponten et al. BMC Surg. .

Abstract

Background: Evidence is accumulating that, similar to other ventral hernias, umbilical and epigastric hernias must be mesh repaired. The difficulties involved in mesh placement and in mesh-related complications could be the reason many small abdominal hernias are still primary closed. In laparoscopic repair, a mesh is placed intraperitoneally, while the most common procedure is open surgery is pre-peritoneal mesh placement. A recently developed alternative method is the so-called patch repair, in this approach a mesh can be placed intraperitoneally through open surgery. In theory, such patches are particularly suitable for small hernias due to a reduction in the required dissection. This simple procedure is described in several studies. It is still unclear whether this new approach is associated with an equal risk of recurrence and complications compared with pre-peritoneal meshes. The material of the patch is in direct contact with intra-abdominal organs, it is unknown if this leads to more complications. On the other hand, the smaller dissection in the pre-peritoneal plane may lead to a reduction in wound complications.

Methods/design: 346 patients suffering from an umbilical or epigastric hernia will be included in a multi-centre patient-blinded trial, comparing mesh repair with patch repair. Randomisation will take place for the two operation techniques. The two devices investigated are a flat pre-peritoneal mesh and a Proceed Ventral Patch®. Stratification will occur per centre. Post-operative evaluation will take place after 1, 3, 12 and 24 months. The number of complications requiring treatment is the primary endpoint. Secondary endpoints are Verbal Descriptor Scale (VDS) pain score and VDS cosmetic score, operation duration, recurrence and costs. An intention to treat analysis will be performed.

Discussion: This trial is one of the first in its kind, to compare different mesh devices in a randomized controlled setting. The results will help to evaluate mesh repair for epigastric an umbilical hernia, and find a surgical method that minimizes the complication rate.

Trial registration: Netherlands Trail Registration (NTR) www.trialregister.nl 2010 NTR2514 NL33995.060.10.

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Figures

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Figure 1
Trial flow-chart.
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References

    1. Stabilini C, Stella M, Frascio M, De Salvo L, Fornaro R, Larghero G, Mandolfino F, Lazzara F, Gianetta E. Mesh versus direct suture for the repair of umbilical and epigastric hernias. Ten-year experience. Ann Ital Chir. 2009;80(3):183–187. - PubMed
    1. Malik AM, Jawaid A, Talpur AH, Laghari AA, Khan A. Mesh versus non-mesh repair of ventral abdominal hernias. J Ayub Med Coll Abbottabad. 2008;20(3):54–56. - PubMed
    1. Farrow B, Awad S, Berger DH, Albo D, Lee L, Subramanian A, Bellows CF. More than 150 consecutive open umbilical hernia repairs in a major Veterans Administration Medical Center. Am J Surg. 2008;196(5):647–651. doi: 10.1016/j.amjsurg.2008.07.018. - DOI - PubMed
    1. Abdel-Baki NA, Bessa SS, Abdel-Razek AH. Comparison of prosthetic mesh repair and tissue repair in the emergency management of incarcerated para-umbilical hernia: a prospective randomized study. Hernia. 2007;11(2):163–167. doi: 10.1007/s10029-007-0189-4. - DOI - PubMed
    1. Eryilmaz R, Sahin M, Tekelioglu MH. Which repair in umbilical hernia of adults: primary or mesh? Int Surg. 2006;91(5):258–261. - PubMed

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