Current practice of abdominal fascial closure: a survey of Ontario generalsurgeons

Objectives: To determine the current practice of abdominal fascial closure among provincial general surgeons. The primary objective was to determine t he proportion of surgeons choosing absorbable versus nonabsorbable sutures. Secondary objectives included determining knowledge and attitudes of surge ons to evidence-based medicine and concordance of current practice with lev el I evidence. Design: A survey. Setting: The province of Ontario. Particip ants: One hundred general surgeons. Methods: A stratified random sample of community and academic surgeons was assembled and a questionnaire was maile d to them. Common clinical scenarios and questions pertaining to attitudes and knowledge of evidence-based medicine were included. Main outcome measur es: Use of absorbable versus nonabsorbable suture material. Willingness to change current practice on evidence-based level I reports. Results: Most su rgeons (86%) chose an absorbable suture for abdominal fascial closure. Nona bsorbable suture was chosen by 58% of surgeons in the highly contaminated s urgical scenario. Eighty-one percent of surgeons indicated they would be wi lling to change their current practice of fascial closure if there was evid ence that the incidence of wound complications was reduced. Polyglactin (Vi cryl) was the most commonly chosen suture. Conclusions: The current practic e of abdominal fascial closure among Ontario general surgeons is in disagre ement with the findings from a recent meta-analysis, recommending a nonabso rbable suture for a 32% relative risk reduction in the incisional. hernia r ate. The majority of surgeons employ a continuous absorbable closure in com mon surgical scenarios. A definitive randomized controlled trial comparing continuous nonabsorbable closure versus continuous absorbable closure is wa rranted.