Andrea Balla, Federica Saraceno, Marika Rullo, Salvador Morales-Conde, Eduardo M Targarona Soler, Salomone Di Saverio, Mario Guerrieri, Pasquale Lepiane, Nicola Di Lorenzo, Michel Adamina, Isaias Alarcón, Alberto Arezzo, Jesus Bollo Rodriguez, Luigi Boni, Sebastiano Biondo, Francesco Maria Carrano, Manish Chand, John T Jenkins, Justin Davies, Salvadora Delgado Rivilla, Paolo Delrio, Ugo Elmore, Eloy Espin-Basany, Alessandro Fichera, Blas Flor Lorente, Nader Francis, Marcos Gómez Ruiz, Dieter Hahnloser, Eugenio Licardie, Carmen Martinez, Monica Ortenzi, Yves Panis, Carlos Pastor Idoate, Alessandro M Paganini, Miguel Pera, Roberto Perinotti, Daniel A Popowich, Timothy Rockall, Riccardo Rosati, Alberto Sartori, Daniele Scoglio, Mostafa Shalaby, Vicente Simó Fernández, Neil J Smart, Antonino Spinelli, Patricia Sylla, Pieter J Tanis, Javier Valdes Hernandez, Steven D Wexner, Pierpaolo Sileri
{"title":"Protective ileostomy creation after anterior resection of the rectum (PICARR): a decision-making exploring international survey.","authors":"Andrea Balla, Federica Saraceno, Marika Rullo, Salvador Morales-Conde, Eduardo M Targarona Soler, Salomone Di Saverio, Mario Guerrieri, Pasquale Lepiane, Nicola Di Lorenzo, Michel Adamina, Isaias Alarcón, Alberto Arezzo, Jesus Bollo Rodriguez, Luigi Boni, Sebastiano Biondo, Francesco Maria Carrano, Manish Chand, John T Jenkins, Justin Davies, Salvadora Delgado Rivilla, Paolo Delrio, Ugo Elmore, Eloy Espin-Basany, Alessandro Fichera, Blas Flor Lorente, Nader Francis, Marcos Gómez Ruiz, Dieter Hahnloser, Eugenio Licardie, Carmen Martinez, Monica Ortenzi, Yves Panis, Carlos Pastor Idoate, Alessandro M Paganini, Miguel Pera, Roberto Perinotti, Daniel A Popowich, Timothy Rockall, Riccardo Rosati, Alberto Sartori, Daniele Scoglio, Mostafa Shalaby, Vicente Simó Fernández, Neil J Smart, Antonino Spinelli, Patricia Sylla, Pieter J Tanis, Javier Valdes Hernandez, Steven D Wexner, Pierpaolo Sileri","doi":"10.1007/s13304-025-02111-6","DOIUrl":null,"url":null,"abstract":"<p><p>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.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Updates in Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s13304-025-02111-6","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
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.
期刊介绍:
Updates in Surgery (UPIS) has been founded in 2010 as the official journal of the Italian Society of Surgery. It’s an international, English-language, peer-reviewed journal dedicated to the surgical sciences. Its main goal is to offer a valuable update on the most recent developments of those surgical techniques that are rapidly evolving, forcing the community of surgeons to a rigorous debate and a continuous refinement of standards of care. In this respect position papers on the mostly debated surgical approaches and accreditation criteria have been published and are welcome for the future.
Beside its focus on general surgery, the journal draws particular attention to cutting edge topics and emerging surgical fields that are publishing in monothematic issues guest edited by well-known experts.
Updates in Surgery has been considering various types of papers: editorials, comprehensive reviews, original studies and technical notes related to specific surgical procedures and techniques on liver, colorectal, gastric, pancreatic, robotic and bariatric surgery.