title: Current practice in abdominoperineal resection: an email survey of the membership of the Association of Coloproctology.
abstract: BACKGROUND
  This study aimed to gain insight into current preferences for type of surgical approach and patient positioning in abdominoperineal excision of the rectum (APER), to identify whether these factors affect self-reported oncological outcomes and complication rates, and to  assess the opinions of members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) with regards to the benefit of a national training programme for APER surgery.
  
  
  METHODS
  Members of the ACPGBI were surveyed using a questionnaire designed to examine surgeon/departmental  demographics, type of APER practised, audit of results and complications, opinions regarding extralevator APER (ELAPER) and opinions regarding the potential benefit of a national training programme.
  
  
  RESULTS
  According to the survey, 62% of surgeons perform perineal dissection in the supine  position and 57% perform a standard APER technique. Surgeons who only practise colorectal surgery (p=0.002) and surgeons performing prone dissection (p<0.0001) are more likely to perform ELAPER. Three-quarters (76%) audit their results for perineal wound complication rates.  Over 80% audit their oncological outcomes. The vast majority (94.6%) of those who perform ELAPER believe there is a benefit to this method while 59.6% of those who do not perform ELAPER still believe there is a benefit to ELAPER. Only 50% feel that there should be a national training programme.
  
  
  CONCLUSIONS
  There is a distinct discordance with regards to the APER technique. Among UK colorectal surgeons, although a significant proportion favours ELAPER, there remains a larger proportion still performing standard APER techniques.
authors.affiliation: Portsmouth Hospitals NHS Trust, UK. ndabbas@gmail.com
authors.forename: N
authors.initials: N
authors.lastname: Dabbas
authors.forename: K
authors.initials: K
authors.lastname: Adams
authors.forename: H
authors.initials: H
authors.lastname: Chave
authors.forename: G
authors.initials: G
authors.lastname: Branagan
mesh_terms: D000005:Abdomen / Q000601:surgery*; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D015179:Colorectal Neoplasms / Q000601:surgery*; D003107:Colorectal Surgery / Q000379:methods*; D004210:Dissection / Q000379:methods; D006801:Humans; D008485:Medical Audit; D010502:Perineum / Q000601:surgery*; D011183:Postoperative Complications; D011364:Professional Practice / Q000706:statistics & numerical data*; D016896:Treatment Outcome