Abstract：
BACKGROUND: Component separation (CS) procedures have become an important part of surgeons\' armamentarium. However, the exact criteria for training, procedure/mesh choice, as well as patient selection for CS remains undefined. Herein we aimed to identify trends in CS utilization between various cohorts of practicing surgeons.
METHODS: Members of the Americas Hernia Society were queried using an online survey. Responders were stratified according to their experience, practice profile (private vs academic, general vs hernia surgery), and volume (low (< 10/year) vs high) of CS procedures. We used Chi-squared tests to evaluate significant associations between surgeon characteristics and outcomes.
RESULTS: 275 responses with overwhelming male preponderance (88%) were collected. The two most common self-identifiers were \"general\" (66%) and \"hernia\" (28%) surgeon. PCS was the most commonly (67%) used type of CS; endoscopic ACS was least common (3%). Low-volume surgeons were more likely to utilize the ACS (p < 0.05). Only 7% of respondents learned PCS during their residency, as compared to 36% that use ACS. 65% felt 0-10 cases was sufficient to become proficient in their preferred technique. 10 cm-wide defect was the most common indication for CS; 23% used it for 5-8 cm defects. Self-identified \"hernia\" and high-volume surgeons were more likely to use synthetic mesh in the setting of previous wound infections and/or contaminated field (p < 0.05). More general/low-volume surgeons use biologic mesh. Contraindications to elective CS varied widely in the cohort, and 9.5% would repair poorly optimized patients electively. Severe morbid obesity was the most feared comorbidity to preclude CS.
CONCLUSIONS: The use of CS varies widely between surgeons. In this cohort, we discovered that PCS was the most commonly used technique, especially by hernia/high-volume surgeons. There are differences in mesh utilization between high-volume and low-volume surgeons, specifically in contaminated fields. Despite its prevalence, CS training, indications/contraindications, and patient selection must be better defined.
METHODS: Members of the Americas Hernia Society were queried using an online survey. Responders were stratified according to their experience, practice profile (private vs academic, general vs hernia surgery), and volume (low (< 10/year) vs high) of CS procedures. We used Chi-squared tests to evaluate significant associations between surgeon characteristics and outcomes.
RESULTS: 275 responses with overwhelming male preponderance (88%) were collected. The two most common self-identifiers were \"general\" (66%) and \"hernia\" (28%) surgeon. PCS was the most commonly (67%) used type of CS; endoscopic ACS was least common (3%). Low-volume surgeons were more likely to utilize the ACS (p < 0.05). Only 7% of respondents learned PCS during their residency, as compared to 36% that use ACS. 65% felt 0-10 cases was sufficient to become proficient in their preferred technique. 10 cm-wide defect was the most common indication for CS; 23% used it for 5-8 cm defects. Self-identified \"hernia\" and high-volume surgeons were more likely to use synthetic mesh in the setting of previous wound infections and/or contaminated field (p < 0.05). More general/low-volume surgeons use biologic mesh. Contraindications to elective CS varied widely in the cohort, and 9.5% would repair poorly optimized patients electively. Severe morbid obesity was the most feared comorbidity to preclude CS.
CONCLUSIONS: The use of CS varies widely between surgeons. In this cohort, we discovered that PCS was the most commonly used technique, especially by hernia/high-volume surgeons. There are differences in mesh utilization between high-volume and low-volume surgeons, specifically in contaminated fields. Despite its prevalence, CS training, indications/contraindications, and patient selection must be better defined.
摘要：
背景：成分分离（CS）程序已成为外科医生\'armamentarium的重要组成部分。然而,培训的确切标准，程序/网格选择，以及CS的患者选择仍未定义。在这里，我们的目的是确定不同队列的执业外科医生之间的CS利用趋势。
方法：使用在线调查对美洲疝协会成员进行了查询。反应者根据他们的经验进行分层，实践简介(私人与学术，一般与疝气手术），和CS程序的数量（低（<10/年）与高）。我们使用卡方检验来评估外科医生特征和结果之间的显著关联。
结果：收集了275个反应，男性占绝大多数（88％）。两个最常见的自我标识符是“普通”（66％）和“疝气”（28％）外科医生。PCS是最常用的CS类型（67％）；内窥镜ACS最不常见（3％）。低容量外科医生更有可能使用ACS（p<0.05）。只有7％的受访者在居住期间学习了PCS，与使用ACS的36％相比。65％的感觉0-10例足以精通其首选技术。10厘米宽的缺损是CS最常见的适应症；23％的人将其用于5-8厘米的缺损。自我识别的“疝气”和高容量外科医生更有可能在先前的伤口感染和/或污染区域中使用合成网状物（p<0.05）。更一般/低容量的外科医生使用生物网。选择性CS的禁忌症在队列中差异很大，9.5%会选择性修复优化不良的患者。严重的病态肥胖是最担心的共病，以排除CS。
结论：外科医生之间CS的使用差异很大。在这个队列中，我们发现PCS是最常用的技术，尤其是疝气/高容量外科医生。大批量和小批量外科医生之间的网格利用率存在差异，特别是在污染的领域。尽管流行,CS培训,适应症/禁忌症,必须更好地定义患者选择。
方法：使用在线调查对美洲疝协会成员进行了查询。反应者根据他们的经验进行分层，实践简介(私人与学术，一般与疝气手术），和CS程序的数量（低（<10/年）与高）。我们使用卡方检验来评估外科医生特征和结果之间的显著关联。
结果：收集了275个反应，男性占绝大多数（88％）。两个最常见的自我标识符是“普通”（66％）和“疝气”（28％）外科医生。PCS是最常用的CS类型（67％）；内窥镜ACS最不常见（3％）。低容量外科医生更有可能使用ACS（p<0.05）。只有7％的受访者在居住期间学习了PCS，与使用ACS的36％相比。65％的感觉0-10例足以精通其首选技术。10厘米宽的缺损是CS最常见的适应症；23％的人将其用于5-8厘米的缺损。自我识别的“疝气”和高容量外科医生更有可能在先前的伤口感染和/或污染区域中使用合成网状物（p<0.05）。更一般/低容量的外科医生使用生物网。选择性CS的禁忌症在队列中差异很大，9.5%会选择性修复优化不良的患者。严重的病态肥胖是最担心的共病，以排除CS。
结论：外科医生之间CS的使用差异很大。在这个队列中，我们发现PCS是最常用的技术，尤其是疝气/高容量外科医生。大批量和小批量外科医生之间的网格利用率存在差异，特别是在污染的领域。尽管流行,CS培训,适应症/禁忌症,必须更好地定义患者选择。
