Balla Andrea, Saraceno Federica, Rullo Marika, Morales-Conde Salvador, Targarona Soler Eduardo M, Di Saverio Salomone, Guerrieri Mario, Lepiane Pasquale, Di Lorenzo Nicola, Adamina Michel, Alarcón Isaias, Arezzo Alberto, Bollo Rodriguez Jesus, Boni Luigi, Biondo Sebastiano, Carrano Francesco Maria, Chand Manish, Jenkins John T, Davies Justin, Delgado Rivilla Salvadora, Delrio Paolo, Elmore Ugo, Espin-Basany Eloy, Fichera Alessandro, Lorente Blas Flor, Francis Nader, Gómez Ruiz Marcos, Hahnloser Dieter, Licardie Eugenio, Martinez Carmen, Ortenzi Monica, Panis Yves, Pastor Idoate Carlos, Paganini Alessandro M, Pera Miguel, Perinotti Roberto, Popowich Daniel A, Rockall Timothy, Rosati Riccardo, Sartori Alberto, Scoglio Daniele, Shalaby Mostafa, Simó Fernández Vicente, Smart Neil J, Spinelli Antonino, Sylla Patricia, Tanis Pieter J, Valdes Hernandez Javier, Wexner Steven D, Sileri Pierpaolo
Department of General and Digestive Surgery, University Hospital Virgen Macarena, University of Sevilla, Seville, Spain.
Unit of General and Digestive Surgery, Hospital Quirónsalud Sagrado Corazón, Seville, Spain.
Updates Surg. 2025 Mar 23. doi: 10.1007/s13304-025-02111-6.
In our previous survey of experts, surgeon's decision-making process (DMP) about protective ileostomy (PI) creation after anterior resection was investigated. Based on our previous data, a multiple choice questionnaire has been developed. The aim is to perform a quantitative analysis of the results obtained from an international survey and to describe the clinical practice worldwide. Ten questions were related to participants' demographics and, 20 questions (of which 17 Likert scale questions) investigated the DMP regarding PI creation. To evaluate the tendency of the answers in the Likert-type questions, the mean of the answers obtained was compared with the mean point of the Likert scale. The survey was completed by 1019 physicians. Neoadjuvant chemoradiotherapy and distance of the anastomosis from the anal verge ≤ 10 cm were each considered alone sufficient to justify creation of a PI, with statistically significant differences in comparison to the mean point of the scales in (p = < 0.0001 in both cases). Total Mesorectal Excision alone was not considered a factor sufficient to create a PI (p = 0.416). Most of the participants agree to define their approach to create a PI "tailored" to patients' risk factors (p = < 0.0001) and "influenced by my experience" in case of patients with low/moderate risk of anastomotic leakage (p = < 0.0001). This study provides useful insights on the worldwide clinical practice regarding creation of PI following anterior resection. Given the lack of standardization and evidence-based guidelines, this analysis may be helpful to assist surgeons' practice.
在我们之前对专家的调查中，研究了外科医生在前切除术后行保护性回肠造口术（PI）的决策过程（DMP）。基于我们之前的数据，开发了一份多项选择题问卷。目的是对国际调查所得结果进行定量分析，并描述全球的临床实践。10个问题与参与者的人口统计学特征相关，20个问题（其中17个为李克特量表问题）调查了关于PI创建的DMP。为评估李克特式问题答案的倾向，将所得答案的平均值与李克特量表的平均得分进行比较。1019名医生完成了该调查。新辅助放化疗以及吻合口距肛缘≤10 cm各自单独被认为足以作为行PI的理由，与量表平均得分相比有统计学显著差异（两种情况均为p = ＜0.0001）。单纯的全直肠系膜切除术不被认为是行PI的充分因素（p = 0.416）。大多数参与者同意将他们创建PI的方法定义为“根据”患者的危险因素“量身定制”（p = ＜0.0001），并且对于吻合口漏低/中度风险的患者，“受我的经验影响”（p = ＜0.0）。本研究为前切除术后PI创建的全球临床实践提供了有用的见解。鉴于缺乏标准化和循证指南，该分析可能有助于指导外科医生的实践。
