Surgeon perspectives on options for ventral abdominal wall hernia repair: results of a postal questionnaire.
BACKGROUND
Ventral abdominal wall hernias are a common cause of morbidity and mortality. Opinion varies as to appropriate management. A recent consensus meeting on incisional hernia identified the need to standardise repair. On this background, a survey of current practice was performed.


METHODS
A questionnaire was sent to 101 practicing general surgeons within the West of Scotland. Incisional, epigastric and para-umbilical defects were subdivided into defect size <2, 2-5 and >5 cm. The surgeons were asked to indicate the most appropriate repair (suture, mayo or mesh) for each. The influence of reducibility on the decision to repair was also assessed.


RESULTS
Sixty-one of 101 questionnaires were returned valid giving a response rate of 60%. Suture repair was significantly more likely to be used in all defects <2 cm (P<0.001). Mesh repair was significantly more likely to be recommended in all defects >5 cm (P<0.001). Of defects >5-cm, mesh was recommended for 90% of incisional hernia compared with 81% of epigastric and 76% of para-umbilical hernia (P<0.001). There was no significant difference in choice of repair for defect size 2-5 cm with opinion divided between suture and mesh. Irreducibility increased the likelihood of recommendation for repair.


CONCLUSIONS
This survey shows a lack of consensus on the appropriate repair of ventral abdominal wall hernia among practicing consultant general surgeons. This reflects the contrasting views within the current literature.
Witherspoon
P
P
Department of Surgery, University Department of Surgery, Western Infirmary, Dumbarton Road, Glasgow G11 6NT, Scotland, UK. paul_witherspoon@hotmail.com
O'Dwyer
P J
PJ
D034861:Abdominal Wall / Q000601:surgery; D003625:Data Collection; D013502:General Surgery; D006555:Hernia, Ventral / Q000473:pathology / Q000601:surgery*; D006801:Humans; D012606:Scotland; D013526:Surgical Mesh / Q000706:statistics & numerical data; D013536:Suture Techniques; D013537:Sutures / Q000706:statistics & numerical data