title: Practice patterns in complex ventral hernia repair and place of biological grafts: a national survey among French digestive academic surgeons.
abstract: BACKGROUND
  Despite the prevalence of complex ventral hernias, there is little agreement on the most appropriate technique or prosthetic to repair these defects, especially in contaminated fields. Our objective was to determine French surgical practice patterns among academic surgeons in complex ventral hernia repair (CVHR) with regard to indications, most appropriate techniques, choice of prosthesis, and experience with complications.
  
  
  METHODS
  A survey consisting of 21 questions and 6 case-scenarios was e-mailed to French practicing academic surgeons performing CVHR, representing all French University Hospitals.
  
  
  RESULTS
  Forty over 54 surgeons (74%) responded to the survey, representing 29 French University Hospitals. Regarding the techniques used for CVHR, primary closure without reinforcement was provided in 31.6% of cases, primary closure using the component separation technique without mesh use in 43.7% of cases, mesh positioned as a bridge in 16.5% of cases, size reduction of the defect by using aponeurotomy incisions without mesh use in 8.2% of cases. Among the 40 respondents, 36 had experience with biologic mesh. There was a strong consensus among surveyed surgeons for not using synthetic mesh in contaminated or dirty fields (100%), but for using it in clean settings (100%). There was also a strong consensus between respondents for using biologic mesh in contaminated (82.5%) or infected (77.5%) fields and for not using it in clean setting (95%). In clean-contaminated surgery, there was no consensus for defining the optimal therapeutic strategy in CVHR. Infection was the most common complication reported after biologic mesh used (58%). The most commonly reported influences for the use of biologic grafts included literature, conferences and discussion with colleagues (85.0%), personal experience (45.0%) and cost (40.0%).
  
  
  CONCLUSIONS
  Despite a lack of level I evidence, biologic meshes are being used by 90% of surveyed surgeons for CVHR. Importantly, there was a strong consensus for using them in contaminated or infected fields and for not using them in clean setting. To better guide surgeons, prospective, randomized trials should be undertaken to evaluate the short- and long-term outcomes associated with these materials in various surgical wound classifications.
authors.affiliation: Department of digestive and oncological surgery, Claude-Huriez University Hospital, place de Verdun, 59037 Lille cedex, France. Electronic address: Christophe.mariette@chru-lille.fr.
authors.forename: C
authors.initials: C
authors.lastname: Mariette
authors.affiliation: Department of digestive surgery, University Hospital of Avicennes, Avicennes, France.
authors.forename: P
authors.initials: P
authors.lastname: Wind
authors.affiliation: Department of digestive surgery, University Hospital Pitié-Salpétrière, Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Micelli Lupinacci
authors.affiliation: Department of digestive surgery, University Hospital Pitié-Salpétrière, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Tresallet
authors.affiliation: Department of digestive surgery, University Hospital E.-Herriot, Lyon, France.
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authors.lastname: Adham
authors.affiliation: Department of digestive surgery, University Hospital of Grenoble, Grenoble, France.
authors.forename: C
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authors.lastname: Arvieux
authors.affiliation: Department of digestive surgery, University Hospital of Kremlin-Bicêtre, Le Kremlin-Bicêtre, France.
authors.forename: S
authors.initials: S
authors.lastname: Benoist
authors.affiliation: Department of digestive surgery, Nord University Hospital, Marseille, France.
authors.forename: S
authors.initials: S
authors.lastname: Berdah
authors.affiliation: Department of digestive surgery, Georges-Pompidou European University Hospital, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Berger
authors.affiliation: Department of digestive and oncological surgery, Claude-Huriez University Hospital, place de Verdun, 59037 Lille cedex, France.
authors.forename: N
authors.initials: N
authors.lastname: Briez
authors.affiliation: Department of digestive surgery, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: C
authors.initials: C
authors.lastname: Brigand
authors.affiliation: Department of visceral and endocrine surgery, University Hospital of Lille, Lille, France.
authors.forename: R
authors.initials: R
authors.lastname: Caiazzo
authors.affiliation: Department of digestive surgery, University Hospital of Toulouse, Toulouse, France.
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authors.lastname: Carrere
authors.affiliation: Department of digestive surgery, University Hospital of Angers, Angers, France.
authors.forename: C
authors.initials: C
authors.lastname: Casa
authors.affiliation: Department of digestive surgery, Haut-Leveque University Hospital, Bordeaux, France.
authors.forename: D
authors.initials: D
authors.lastname: Collet
authors.affiliation: Department of digestive surgery, University Hospital of Reims, Reims, France.
authors.forename: S
authors.initials: S
authors.lastname: Deguelte
authors.affiliation: Department of digestive surgery, Cochin University Hospital, Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Dousset
authors.affiliation: Department of digestive surgery, Pellegrin University Hospital, Bordeaux, France.
authors.forename: V
authors.initials: V
authors.lastname: Dubuisson
authors.affiliation: Department of digestive surgery, Lyon-Sud University Hospital, Lyon, France.
authors.forename: O
authors.initials: O
authors.lastname: Glehen
authors.affiliation: Department of digestive surgery, Saint-André University Hospital, Bordeaux, France.
authors.forename: J-C
authors.initials: JC
authors.lastname: Gineste
authors.affiliation: Department of digestive surgery, University Hospital of Angers, Angers, France.
authors.forename: A
authors.initials: A
authors.lastname: Hamy
authors.affiliation: Department of digestive surgery, Tenon University Hospital, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Lacaine
authors.affiliation: Department of digestive surgery, Saint-André University Hospital, Bordeaux, France.
authors.forename: C
authors.initials: C
authors.lastname: Laurent
authors.affiliation: Department of digestive surgery, University Hospital of Nantes, Nantes, France.
authors.forename: P-A
authors.initials: PA
authors.lastname: Lehur
authors.affiliation: Department of digestive surgery, Croix-Rousse University Hospital, Lyon, France.
authors.forename: J-Y
authors.initials: JY
authors.lastname: Mabrut
authors.affiliation: Department of digestive surgery, University Hospital of Besançon, Besançon, France.
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authors.lastname: Mathieu
authors.affiliation: Department of digestive surgery, University Hospital of Limoges, Limoges, France.
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authors.lastname: Mathonnet
authors.affiliation: Department of digestive surgery, University Hospital of Rennes, Rennes, France.
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authors.lastname: Meunier
authors.affiliation: Department of digestive surgery, University Hospital of Rouen, Rouen, France.
authors.forename: F
authors.initials: F
authors.lastname: Michot
authors.affiliation: Department of digestive surgery, Timone University Hospital, Marseille, France.
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authors.lastname: Ouaissi
authors.affiliation: Department of digestive surgery, University Hospital of Reims, Reims, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Palot
authors.affiliation: Department of digestive surgery, Saint-Antoine University Hospital, Paris, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Parc
authors.affiliation: Department of visceral and endocrine surgery, University Hospital of Lille, Lille, France.
authors.forename: F
authors.initials: F
authors.lastname: Pattou
authors.affiliation: Department of digestive surgery, Saint-Antoine University Hospital, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Paye
authors.affiliation: Department of digestive surgery, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: D
authors.initials: D
authors.lastname: Pezet
authors.affiliation: Department of digestive and oncological surgery, Claude-Huriez University Hospital, place de Verdun, 59037 Lille cedex, France.
authors.forename: G
authors.initials: G
authors.lastname: Piessen
authors.affiliation: Department of digestive surgery, Lariboisière University Hospital, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Pocard
authors.affiliation: Department of digestive surgery, University Hospital of Nantes, Nantes, France.
authors.forename: N
authors.initials: N
authors.lastname: Regenet
authors.affiliation: Department of digestive surgery, Amiens University Hospital, Amiens, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Regimbeau
authors.affiliation: Department of digestive surgery, Amiens University Hospital, Amiens, France.
authors.forename: C
authors.initials: C
authors.lastname: Sabbagh
authors.affiliation: Department of general surgery and transplantation, University Hospital of Lille, Lille, France.
authors.forename: P
authors.initials: P
authors.lastname: Zerbib
authors.affiliation: Hull Associates, Medtech consulting, 100 Ledgewood Place, Suite 204, Rockland, Massachusetts 02370, USA.
authors.forename: J-M
authors.initials: JM
authors.lastname: Toussaint
mesh_terms: D001291:Attitude of Health Personnel; D032921:Consensus; D005260:Female; D005602:France; D019538:Health Care Surveys; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013526:Surgical Mesh
keywords: Abdominal wall reconstruction; Biologic mesh; Contaminated field; Prosthetic; Survey; Ventral hernia repair