title: [Surgical strategy in acute or elective sigmoid resection in The Netherlands; survey based on a marketing model].
abstract: OBJECTIVE
  To gain insight into the operative strategies used by Dutch surgeons for complicated diverticulitis and sigmoid carcinoma, and into the influence of patient risk factors and surgeon's experience on the preferred operative strategy.
  
  
  METHODS
  Descriptive.
  
  
  METHODS
  A questionnaire was sent to all 148 members of the Dutch Society of Gastrointestinal Surgery, concerning 32 fictitious patients with sigmoid pathology. It was based on conjoint-analysis, a model used in marketing research. This model analyses qualities that make a product preferable to another product of the same product group. The operative choices were: resection with Hartmann's procedure, resection with primary anastomosis after on-table lavage, or with primary anastomosis only, or no primary resection but diverting stoma only, or some personal technique. The survey focused on experience of the surgeons with the operative procedures, and on treatment choices in four fictitious cases frequently encountered in general surgery.
  
  
  RESULTS
  There was little agreement concerning the preferred surgical option for treatment of complicated diverticular disease or sigmoid carcinoma. With the exception of one fictitious young, electively operated 'ideal' patient (resection with primary anastomosis) there is hardly any consensus among the surgeons with respect to preferred treatment.
  
  
  CONCLUSIONS
  Reasons to depart from the conceptually optimal treatment (resection and anastomosis) in complicated cases (from the point of view of the surgeon or the patient), and absence of agreement on responsible other treatment could be differences in appraisal of the importance of several risk factors, or differences in acquired decision making strategies. The literature offers no answer to the question which techniques should be preferred under various circumstances.
authors.affiliation: Academisch Ziekenhuis, afd. Heelkunde, Leiden.
authors.forename: A W
authors.initials: AW
authors.lastname: Gooszen
authors.forename: R H
authors.initials: RH
authors.lastname: Geelkerken
authors.forename: R A
authors.initials: RA
authors.lastname: Tollenaar
authors.forename: D R
authors.initials: DR
authors.lastname: Timmermans
authors.forename: J
authors.initials: J
authors.lastname: Kievit
authors.forename: H G
authors.initials: HG
authors.lastname: Gooszen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D002983:Clinical Competence; D004766:Enterostomy / Q000379:methods; D006801:Humans; D008389:Marketing of Health Services; D008875:Middle Aged; D009426:Netherlands; D010347:Patient Care Planning; D012810:Sigmoid Diseases / Q000601:surgery*; D013043:Specialties, Surgical; D013514:Surgical Procedures, Operative / Q000379:methods*; D011795:Surveys and Questionnaires
vernacular_title: Operatieve strategie bij de acute of electieve sigmoïdresectie in Nederland; enquête op basis van een marketingmodel.