1. Do North American colorectal surgeons use mesh to prevent parastomal hernia? A survey of current attitudes and practice
- Author
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Holland, Jessica, Chesney, Tyler, Dossa, Fahima, Acuna, Sergio, Fleshner, Katherine Anne, and Baxter, Nancy N.
- Subjects
Hernia -- Prevention -- Usage ,Surgeons -- Surveys -- Usage ,Colostomy ,Physicians ,Health ,Health care industry - Abstract
Background: The use of prophylactic mesh in end colostomy procedures has been shown to reduce the rate of parastomal hernia. However, the degree to which the practice has been adopted clinically remains unknown. We conducted a study to evaluate the current opinions and practice patterns of Canadian and US colorectal surgeons with regard to the use of prophylactic mesh in end colostomy. Methods: Between May and July 2017, we conducted an internet-based survey of colorectal surgeons in Canada and the United States (selected at random). Using a questionnaire designed and tested for this study, we assessed the rate of mesh use, types of mesh and placement techniques, and perceived barriers and facilitators associated with the practice. Results: Forty-eight (51.6%) of 93 invited Canadian surgeons and 253 (16.6%) of 1521 invited US surgeons responded (overall response rate 18.6%). Of the 301 respondents, 32 (10.6%) were currently using mesh, 32 (10.6%) had previously used mesh, and 237 (78.7%) had never used mesh. Of 29 respondents currently using mesh, 12 (41.4%) used it only in selected patients; the majority used a sublay technique (20 [69.0%]) and biologic mesh (17 [58.6%]). Most respondents agreed that parastomal hernias are common and negatively affect quality of life; however, there remained concerns about evidence quality and the perceived risk associated with mesh among those who had never or had previously used mesh. Conclusion: Prophylactic mesh placement remains relatively uncommon; when used, biologic mesh was the most common type. Many surgeons were not convinced of the safety or efficacy of prophylactic mesh placement. Contexte: Il a ete demontre que la pose d'un treillis prophylactique durant une colostomie terminale reduit le risque de hernie parastomale. On ignore toutefois a quel point cette pratique a ete adoptee en contexte clinique. Nous avons mene une etude pour connaitre l'opinion et les habitudes des chirurgiens colorectaux canadiens et americains quant a cette intervention. Methodes: De mai a juillet 2017, nous avons mene un sondage en ligne aupres de chirurgiens colorectaux canadiens et americains selectionnes aleatoirement. A l'aide d'un questionnaire concu et valide pour cette etude, nous avons evalue le taux de pose de treillis, le type de treillis et la technique utilise, ainsi que les facteurs facilitant ou limitant l'intervention. Resultats: Au total, 48 des 93 chirurgiens canadiens (51,6%) et 253 des 1521 chirurgiens americains (16,6%) approches ont repondu au sondage (taux de reponse global: 18,6%). Sur les 301 repondants, 32 (10,6%) ont dit qu'ils installent actuellement des treillis, 32 (10,6%) ont dit en avoir installe, et 237 (78,7%) ont dit n'en avoir jamais installe. Parmi 29 repondants posant actuellement des treillis, 12 (41,4%) ont declare y avoir recours pour certains patients seulement; la majorite pose les treillis dans l'espace preperitoneal (20 [69,0%]) et se sert de treillis biologiques (17 [58,6%]). La plupart des repondants s'entendaient pour dire que les hernies parastomales sont courantes et ont des repercussions negatives sur la qualite de vie des patients; cependant, les chirurgiens n'ayant jamais installe de treillis ou en ayant seulement installe par le passe se sont dits preoccupes par la qualite des donnees et les risques percus associes aux treillis. Conclusion: La pose d'un treillis a des fins prophylactiques demeure relativement rare. Les treillis biologiques etaient les plus frequemment utilises par les repondants. Bon nombre des chirurgiens questionnes n'etaient pas convaincus de l'innocuite ou de l'efficacite de l'intervention., Parastomal hernias are a predictable consequence of the fascial defect created for an ostomy and represent a major source of morbidity for patients with stomas. (1,2) The incidence of parastomal [...]
- Published
- 2019
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