ROCSS is a randomised controlled trial assessing the placement of biological mesh in order to reduce the rate of hernias at the site of stoma closure. Strattice is a well-established biological mesh/ tissue matrix which would be compared against a control arm of no mesh placement.
The Rationale for a Trial
Closure of complex and contaminated abdominal wounds is challenging and carries risks, including wound dehiscence and incisional hernias. Use of biological meshes in these situations may provide a safe method of reducing these complications, especially long-term incisional hernias. ROCSS will use stoma site closure as a model for biological mesh placement during any difficult contaminated abdominal wall closures.
Hernia at the site of stoma closure occurs in up to 30% of patients and is associated with adverse effects on quality of life. In up to 10% of cases, patients are submitted to complex re-operation which carries significant morbidity. Not all patients will report symptoms or undergo repair, as they do not wish to have a further major operation. Incisional hernias at the site of stomas closure form an important and well defined subgroup. If there is a measurable benefit from mesh insertion, elective use of a collagen mesh would warrant consideration in the closure of other difficult, contaminated abdominal wounds. This study will also provide useful information on the value of using a CT scan as an early diagnostic tool of herniation, which could then be used in future abdominal wall studies as a surrogate endpoint for clinical hernia.
The aim of the ROCSS trial is to assess whether a biological mesh (collagen tissue matrix) reduces the incidence of clinically detectable stoma closure site hernias at two years compared to standard closure techniques.
ROCSS is a prospective, multi-centre randomised controlled trial.
ROCSS is designed in two stages:
i) a feasibility study
ii) a Phase III multi-centre RCT
The feasibility phase assessed recruitment, the randomisation process and deliverability of the treatment.
The Phase III study is a prospective, multi-centre RCT to determine if the use of a collagen tissue matrix (Strattice®) reduces the incidence of clinically detectable stoma closure site hernias at two years as compared to standard closure techniques.
The trial aims to randomise 560 patients in 2 years. The end date for recruitment is 31-May-2015 with trial follow-up being completed in summer 2017.
UPDATE: Recruitment has been extedned until 30-Sep-2015 with the aim of increasing the sample size to 790 as recruiment is going so strongly. This will increase the statistical power from 80% to 90%.
The objectives of the feasibility study were:
- To develop strategies for effective recruitment and randomisation
- To assess the deliverability of the mesh placement technique
The outcome measures for the feasibility study were
- Patient identification and randomisation proces
- Deliverability and safety of technique for mesh placement
The feasibility study showed that patient recruitment and the randomisation process were feasible and that the technique to be used for reinforcement of the stoma closure site with the collagen mesh is deliverable. We have therefore run seamlessly on from the feasibility study with recruitment for the main full phase III trial.