STANDARD GAMBLE SURGEON SURVEY Step 1 of 11 - SURGEON INFORMATION 0% Specialty*Age*Choose oneUnder 1818-2425-3435-4445-5455-6465 or AbovePrefer Not to AnswerGender*Choose oneMaleFemaleOtherPrefer not to sayCity*State*Choose oneAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificHow many laparotomies do you perform per year? (Provide an estimation)*How many ventral hernia repairs do you perform per year? (Provide an estimation)*What percentage of your non-hernia abdominal cases do you use prophylactic mesh for? Enter a number between 1 and 100.*How many laparoscopic surgeries do you perform per year? (Provide an estimation)*What are the reasons you use or avoid the use of prophylactic mesh for prevention of incisional ventral hernias?* The following three hypothetical scenarios are surgical cases in which prophylactic mesh could be considered to reduce risk of developing an incisional hernia. Laparoscopic Cholecystectomy: Low Risk Scenario ⚬ This patient is a 42-year old woman here for an elective laparoscopic cholecystectomy. ⚬ BMI = 24 kg/m2 ⚬ Past Medical History: • Diabetes mellitus • Hypertension ⚬ Labs: • WBC normal • LFTs normal ⚬ Imaging • Ultrasound shows a 3 cm gallstone, GBW 0.3 cm, CBD 0.3 cm. At the moment of gallbladder extraction, incision had to be extended to 3 cm Below is a flow diagram of possible complications with current care. Below is a flow diagram of possible complications with prophylactic mesh. The patient is a 42-year old woman here for an elective laparoscopic cholecystectomy. She has a BMI of 24 kg/m2 and past medical history of diabetes mellitus and hypertension. Her labs show normal WBC count and normal LFTs. Ultrasound shows a 3 cm gallstone with GBW 0.3 cm and CBD 0.3 cm. At the moment of the gallbladder extraction, the incision has to be extended to 3 cm. CURRENT PRACTICE Risk of hernia → 5% Risk of wound complication → 2% PROPHYLACTIC MESH Risk of hernia → 1.6% Risk of wound complication → ? Considering the risks with prophylactic mesh compared to current practice, do you accept the mesh therapy at a 2% risk of wound complication?*YesNoConsidering the risks with prophylactic mesh compared to current practice, do you accept the mesh therapy at a 3% risk of wound complication?*YesNoConsidering the risks with prophylactic mesh compared to current practice, do you accept the mesh therapy at a 4% risk of wound complication?*YesNoConsidering the risks with prophylactic mesh compared to current practice, do you accept the mesh therapy at a 5% risk of wound complication?*YesNoChoose the highest % risk of wound complications with mesh therapy that you are willing to take.Considering the risks with prophylactic mesh compared to current practice, do you accept the mesh therapy at a 6% risk of wound complication?*YesNoChoose the highest % risk of wound complications with mesh therapy that you are willing to take.Considering the risks with prophylactic mesh compared to current practice, do you accept the mesh therapy at a 7% risk of wound complication?*YesNoChoose the highest % risk of wound complications with mesh therapy that you are willing to take.Considering the risks with prophylactic mesh compared to current practice, do you accept the mesh therapy at a 12% risk of wound complication?*YesNoChoose the highest % risk of wound complications with mesh therapy that you are willing to take.Considering the risks with prophylactic mesh compared to current practice, do you accept the mesh therapy at a 17% risk of wound complication?*YesNoChoose the highest % risk of wound complications with mesh therapy that you are willing to take.Considering the risks with prophylactic mesh compared to current practice, do you accept the mesh therapy at a 22% risk of wound complication?*YesNoChoose the highest % risk of wound complications with mesh therapy that you are willing to take.Click the drop down box below:*%5%6%7%12%17%22% Sigmoidectomy: Medium Risk Scenario ⚬ This patient is a 62 year old male smoker who underwent outpatient colonoscopy which revealed sigmoid diverticulosis. ⚬ BMI = 42 kg/m2 ⚬ Past Medical History: • Diabetes mellitus • Hypertension • History of multiple episodes of diverticulitis Hand assisted laparoscopic sigmoid colectomy is planned for this patient Below is a flow diagram of possible complications with current care. Below is a flow diagram of possible complications with prophylactic mesh. This patient is a 62 year old man who underwent outpatient colonoscopy which revealed sigmoid diverticulosis. His BMI is 42 kg/m2 and he is currently a smoker. Past medical history includes diabetes mellitus and hypertension. He also has a history of multiple episodes of diverticulitis. Hand assisted laparoscopic sigmoid colectomy is planned for this patient. CURRENT PRACTICE Risk of hernia → 22% Risk of wound complication → 10% PROPHYLACTIC MESH Risk of hernia → 7% Risk of wound complication → ? Considering the risks with prophylactic mesh compared to current practice, do you accept the mesh therapy at a 10% risk of wound complication?*YesNoChoose the highest % risk of wound complications with mesh therapy that you are willing to take.Considering the risks with prophylactic mesh compared to current practice, do you accept the mesh therapy at a 11% risk of wound complication?*YesNoChoose the highest % risk of wound complications with mesh therapy that you are willing to take.Considering the risks with prophylactic mesh compared to current practice, do you accept the mesh therapy at a 12% risk of wound complication?*YesNoChoose the highest % risk of wound complications with mesh therapy that you are willing to take.Considering the risks with prophylactic mesh compared to current practice, do you accept the mesh therapy at a 13% risk of wound complication?*YesNoChoose the highest % risk of wound complications with mesh therapy that you are willing to take.Considering the risks with prophylactic mesh compared to current practice, do you accept the mesh therapy at a 14% risk of wound complication?*YesNoChoose the highest % risk of wound complications with mesh therapy that you are willing to take.Considering the risks with prophylactic mesh compared to current practice, do you accept the mesh therapy at a 15% risk of wound complication?*YesNoChoose the highest % risk of wound complications with mesh therapy that you are willing to take.Considering the risks with prophylactic mesh compared to current practice, do you accept the mesh therapy at a 20% risk of wound complication?*YesNoChoose the highest % risk of wound complications with mesh therapy that you are willing to take.Considering the risks with prophylactic mesh compared to current practice, do you accept the mesh therapy at a 25% risk of wound complication?*YesNoChoose the highest % risk of wound complications with mesh therapy that you are willing to take.Considering the risks with prophylactic mesh compared to current practice, do you accept the mesh therapy at a 30% risk of wound complication?*YesNoChoose the highest % risk of wound complications with mesh therapy that you are willing to take.Click the drop down box below:*%101112131415202530 Exploratory Laparotomy: High Risk Scenario ⚬ TThis patient is a 67 year old male smoker who presents with small bowel obstruction ⚬ BMI = 42 kg/m2 ⚬ Past Medical History: • COPD • Diabetes mellitus • Hypertension Patient subsequently undergoes an exploratory laparotomy with lysis of adhesion with resection of small bowel Below is a flow diagram of possible complications with current care. Below is a flow diagram of possible complications with prophylactic mesh. This patient is a 67 year old man who presents with small bowel obstruction. He has a BMI of 42 kg/m2 and is a current smoker. His past medical history consists of COPD, diabetes mellitus, and hypertension. The patient subsequently underwent an exploratory laparotomy with lysis of adhesions and resection of small bowel. CURRENT PRACTICE Risk of hernia → 55% Risk of wound complication → 20% PROPHYLACTIC MESH Risk of hernia → 18% Risk of wound complication → ? Considering the risks with prophylactic mesh compared to current practice, do you accept the mesh therapy at a 21% risk of wound complication?*YesNoChoose the highest % risk of wound complications with mesh therapy that you are willing to take.Considering the risks with prophylactic mesh compared to current practice, do you accept the mesh therapy at a 22% risk of wound complication?*YesNoChoose the highest % risk of wound complications with mesh therapy that you are willing to take.Considering the risks with prophylactic mesh compared to current practice, do you accept the mesh therapy at a 23% risk of wound complication?*YesNoChoose the highest % risk of wound complications with mesh therapy that you are willing to take.Considering the risks with prophylactic mesh compared to current practice, do you accept the mesh therapy at a 24% risk of wound complication?*YesNoChoose the highest % risk of wound complications with mesh therapy that you are willing to take.Considering the risks with prophylactic mesh compared to current practice, do you accept the mesh therapy at a 25% risk of wound complication?*YesNoChoose the highest % risk of wound complications with mesh therapy that you are willing to take.Considering the risks with prophylactic mesh compared to current practice, do you accept the mesh therapy at a 30% risk of wound complication?*YesNoChoose the highest % risk of wound complications with mesh therapy that you are willing to take.Considering the risks with prophylactic mesh compared to current practice, do you accept the mesh therapy at a 35% risk of wound complication?*YesNoChoose the highest % risk of wound complications with mesh therapy that you are willing to take.Considering the risks with prophylactic mesh compared to current practice, do you accept the mesh therapy at a 40% risk of wound complication?*YesNoChoose the highest % risk of wound complications with mesh therapy that you are willing to take.Click the drop down box below:*%2122232425303540 What do you believe are the risks and benefits of prophylactic mesh for prevention of incisional ventral hernias?* A meta-analysis conducted by our lab showed these results on relative risk when using prophylactic mesh: Complications Relative Risk with Prophylactic Mesh Hernia 0.32 (68% decreased risk) Wound complications (SSI and SSO) 1.65 (65% increased risk) Given this data, would you change your practice regarding the use of prophylactic mesh for prevention of incisional ventral hernias?*YesNoWhat are the reasons you would or would not change your practice regarding the use of prophylactic mesh for prevention of incisional ventral hernias?* How did you find this survey?*Via the online ACS forumThe International Symposium on Incisional Hernia Prevention ConferenceDirect emailHow did you find this survey?*Choose oneVia the online ACS forumThe International Symposium on Incisional Hernia Prevention ConferenceDirect emailOtherPlease specify how you found the survey:* Share this:TwitterFacebookLike this:Like Loading...