QUESTIONNAIRE Impact of procedural RCTs on surgical practice

Q1: general Chronic groin pain is the cause of significant morbidity after laparoscopic inguinal repair. What minimal invasive operation technique do you prefer to avoid chronic pain?

Q2: general The preferred timing for the surgical treatment of an acute cholecystitis has been discussed repeatedly. How do you manage patients suffering from acute cholecystitis?

Q3: general One frequently employed type of central venous access system is the Port-à-Cath system. At your center, what is the preferred surgical technique for Port-à-Cath placement?

Q4: general How do you perform the skin incision?

Q5: general Surgical site infection after abdominal wall closure are frequent and are a crucial cause of morbidity for our patients. Do you use triclosan-impregnated polydioxanone sutures for fascia closure to lower the infection rate?

Q6: general For open inguinal using the Lichtenstein technique, how do you fix the mesh?

Q7: colorectal Colonic diverticular disease is still a major clinical problem, ranking fifth in the list of digestive diseases. Sigmoid diverticulitis develops in about 20% of patients with diverticulosis, and is increasingly prevalent in Western countries. What is your primary surgical approach for elective sigmoid resection due to diverticulitis?

Q8: colorectal Laparoscopic for colorectal cancer is associated with definite short-term benefits, and is increasingly practiced worldwide. The limitations of a pure laparoscopic approach include a relative lack of tactile feedback and long procedural time. Hand-assisted laparoscopic was introduced in an attempt to facilitate operation by improving the tactile sensation. What is your technique?

Q9: colorectal Are you conducting mechanical bowel preparation in patients prior to rectal cancer surgery?

Q10: colorectal closure is an operation with an underrated morbidity, including surgical site infection, small bowel obstruction and anastomotic leakage. Surgical site infections, in particular, are a frequent occurrence following the closure of contaminated wounds. What is your preferred method of closing ileostomy wounds?

Q11: colorectal The optimal surgical treatment for perforated diverticulitis has been a matter of debate in the past. The “gold standard” has changed several times. What was the most often performed surgical approach, looking at the last 10 patients with sigmoidal perforated diverticulitis Hinchey III/IV at your center, if all procedures were possible?

Q12: colorectal In patients with acute left-sided malignant colonic obstruction presenting themselves in the emergency department with an ileus, but without evidence of peritonitis. What is your preferred treatment procedure?

Q13: colorectal Anism is believed to be a behavioral disorder in which a failure of relaxation or a paradoxical contraction of the puborectalis muscle occurs during attempted defection. How do you preferably treat patients with anism?

Q14: hpb In Western countries the majority of are performed laparoscopically. What is your standard technique for ?

Q15: hpb In small hepatocellular carcinoma (HCC) radiofrequency ablation (RFA) is increasingly used as therapy of choice. What is your approach for HCC, conforming to the , when transplantation is not an option and RFA as well as resection are both feasible.

Q16: hpb From all the anastomosis required during a Whipple procedure, the pancreatico- is the trickiest and often responsible for postoperative complications. In difficult pancreatico-jejunostomy with a small pancreatic duct and a soft , do you use an external intrapancreatic stent (exteriorized via jejunum to „outside“) ?

Q17: hpb resection for HCC in patients with cirrhosis can be challenging. To control blood loss different vascular inflow occlusion techniques have been described. What is your inflow occlusion technique if needed?

Q18: hpb What is your preferred management of patients with concomitant stones and common stones?

Q19: hpb From all the anastomoses required during a Whipple procedure, the pancreatico-jejunostomy is the trickiest and often responsible for postoperative complications resulting from an anastomotic leakage. What is your anastomotic technique?

Q20: upper GI Which reconstruction method do you preferably use after distal ?

Q21: upper GI Do you routinely wrap an omental pedicle flap around the esophagogastric anastomosis after for esophageal cancer?

Q22: vascular In aortobifemoral bypass surgery for severe aorto-iliac occlusive disease, what is your preferred approach?

Q23: General Information What does convince you to implement a new surgical technique, which will lead to a change of your own surgical practice?

Q24: General Information What are your main reasons not to adopt a new procedural technique after publication of an RCT with significant results on this topic?

Q25: General Information Did you ever implement a new surgical technique only after having seen the technique in a movie?

Q26: General Information Did you ever implement a new surgical technique only after having read a favorable RCT on this new procedural technique?

Q27: General Information Gender

Q28: General Information Surgical Specialty

Q29: General Information Surgical experience (in years) after board examination

Addendum: RCTs underlying questionnaire

Q1: Laparoscopic inguinal hernia repair: transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach: a prospective randomized controlled trial A. M. Krishna, M. C.; Bansal, V. K.; Kumar, S.; Rajeshwari, S.; Chabra, A. Surgical , 2012

A prospective, randomized comparison of long-term outcomes: Chronic groin pain and quality of life following totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repair V. K. M. Bansal, M. C.; Babu, D.; Victor, J.; Kumar, S.; Sagar, R.; Rajeshwari, S.; Krishna, A.; Rewari, V. Surgical Endoscopy 2013

Q2: Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study, NCT00447304) C. N. E. Gutt, J.; Koninger, J.; Harnoss, J. C.; Weigand, K.; Kipfmuller, K.; Schunter, O.; Gotze, T.; Golling, M. T.; Menges, M.; Klar, E.; Feilhauer, K.; Zoller, W. G.; Ridwelski, K.; Ackmann, S.; Baron, A.; Schon, M. R.; Seitz, H. K.; Daniel, D.; Stremmel, W.; Buchler, M. W. Annals of Surgery,2013

Q3: Randomized clinical trial comparing venous cutdown with the Seldinger technique for placement of implantable venous access ports A. W. Nocito, S.; Rufibach, K.; Clavien, P. A.; Weber, M. British Journal of Surgery, 2009

Q4: Diathermy vs. scalpel skin incisions in general surgery: double-blind, randomized, clinical trial M. Shamim World Journal of Surgery, 2009

Q5: Surgical-site infection after abdominal wall closure with triclosan-impregnated polydioxanone sutures: Results of a randomized clinical pathway facilitated trial (NCT00998907) C. S. Justinger, J. E.; Ningel, S.; Gräber, S.; Kollmar, O.; Schilling, M. K. Surgery, 2013

Q6: Randomized, controlled, blinded trial of Tisseel/Tissucol for mesh fixation in patients undergoing Lichtenstein technique for primary inguinal hernia repair: results of the TIMELI trial G. P. Campanelli, M. H.; Hoeferlin, A.; Rosenberg, J.; Champault, G.; Kingsnorth, A.; Miserez, M. Annals of Surgery, 2012

Q7: Laparoscopic sigmoid resection for diverticulitis decreases major morbidity rates: A randomized control trial: Short-term results of the sigma trial B. R. V. Klarenbeek, A. A.; Bergamaschi, R.; Van Der Peet, D. L.; Van Den Broek, W. T.; De Lange, E. S.; Bemelman, W. A.; Heres, P.; Lacy, A. M.; Engel, A. F.; Cuesta, M. A. Annals of Surgery, 2009

A prospective, randomized, single-blind comparison of laparoscopic versus open sigmoid colectomy for diverticulitis P. I. Gervaz, I.; Perneger, T.; Schiffer, E.; Morel, P. Annals of Surgery, 2010

Q8: Australasian Laparoscopic Colon Cancer Study shows that elderly patients may benefit from lower postoperative complication rates following laparoscopic versus open resection R. A. B. Allardyce, P. F.; Frampton, C. M.; Frizelle, F. A.; Hewett, P. J.; Rieger, N. A.; Smith, J. S.; Solomon, M. J.; Stevenson, A. R.; Australasian Laparoscopic Colon Cancer Study, Group British Journal of Surgery, 2010

Randomized clinical trial of laparoscopic versus open left colonic resection M. F. Braga, M.; Zuliani, W.; Vignali, A.; Pecorelli, N.; Di Carlo, V. British Journal of Surgery, 2010

Hand-assisted laparoscopic versus total laparoscopic right colectomy: a randomized controlled trial L. W. T. Ng, L. M.; Cheung, H. Y.; Wong, J. C.; Chung, C. C.; Li, M. K. Colorectal Disease, 2012

Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer B. L. M. Green, H. C.; Collinson, F.; Quirke, P.; Guillou, P.; Jayne, D. G.; Brown, J. M. British Journal of Surgery, 2013

Q9: Rectal cancer surgery with or without bowel preparation: The French GRECCAR III multicenter single-blinded randomized trial F. P. Bretagnol, Y.; Rullier, E.; Rouanet, P.; Berdah, S.; Dousset, B.; Portier, G.; Benoist, S.; Chipponi, J.; Vicaut, E.; French Research Group of Rectal Cancer, Surgery Annals of Surgery, 2010

Q10: Randomized clinical trial of short-term outcomes following purse-string versus conventional closure of ileostomy wounds K. P. Reid, P.; Pollitt, T.; Draganic, B.; Smith, S. R. British Journal of Surgery, 2010

Randomized controlled trial: comparison of two surgical techniques for closing the wound following ileostomy closure: purse string vs direct suture N. G. Dusch, D.; Herrle, F.; Niedergethmann, M.; Kienle, P. Colorectal Disease, 2013

Randomized clinical trial of intestinal ostomy takedown comparing pursestring wound closure vs conventional closure to eliminate the risk of wound infection D. R.-D. Camacho-Mauries, J. L.; Salgado-Nesme, N.; Gonzalez, Q. H.; Vergara-Fernandez, O. Diseases of the Colon & , 2013

Q11: A multicenter randomized clinical trial of primary anastomosis or Hartmann's procedure for perforated left colonic diverticulitis with purulent or fecal peritonitis C. E. R. Oberkofler, A.; Raptis, D. A.; Lehmann, K.; Villiger, P.; Buchli, C.; Grieder, F.; Gelpke, H.; Decurtins, M.; Tempia-Caliera, A. A.; Demartines, N.; Hahnloser, D.; Clavien, P. A.; Breitenstein, S. Annals of Surgery, 2012

Q12: Prospective, controlled, randomized study of intraoperative colonic lavage versus stent placement in obstructive left-sided colonic cancer M. S.-A. Alcantara, X.; Falco, J.; Mora, L.; Bombardo, J.; Navarro, S. World Journal of Surgery, 2011

Endoscopic stenting and elective surgery versus emergency surgery for left-sided malignant colonic obstruction: a prospective randomized trial K. S. Q. Ho, H. M.; Lim, J. F.; Tang, C. L.; Eu, K. W. International Journal of Colorectal Disease, 2012

Colonic endoluminal stenting devices and elective surgery versus emergency subtotal/total colectomy in the management of malignant obstructed left colon carcinoma A. H. E.-S. Ghazal, W. G.; Bessa, S. S.; El-Riwini, M. T.; Hussein, A. M. Journal of Gastrointestinal Surgery, 2013

Q13: Comparative study between surgical and non-surgical treatment of anismus in patients with symptoms of obstructed defecation: a prospective randomized study M. E. N. Faried, A.; Youssef, M.; Omar, W.; El Monem, H. A. Journal of Gastrointestinal Surgery, 2010

Q14: Intermediate results of a prospective randomized controlled trial of traditional four-port laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy M. S. M. Phillips, J. M.; Roberts, K.; Tacchino, R.; Onders, R.; DeNoto, G.; Rivas, H.; Islam, A.; Soper, N.; Gecelter, G.; Rubach, E.; Paraskeva, P.; Shah, S. Surgical Endoscopy, 2012

Single incision versus standard 4-port laparoscopic cholecystectomy: a prospective randomized trial D. J. J. Ostlie, O. O.; Iqbal, C. W.; Sharp, S. W.; Snyder, C. L.; Andrews, W. S.; Sharp, R. J.; Holcomb, G. W., 3rd; St Peter, S. D. Journal of Pediatric Surgery, 2013

Single-incision results in similar pain and quality of life scores compared with multi-incision laparoscopic cholecystectomy: A blinded prospective randomized trial of 100 patients M. Y. Zapf, A.; Leung, D.; Salabat, R.; Denham, W.; Barrera, E.; Butt, Z.; Carbray, J.; Du, H.; Wang, C. E.; Ujiki, M. Surgery, 2013

Q15: A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the Milan criteria J. Y. Huang, L.; Cheng, Z.; Wu, H.; Du, L.; Wang, J.; Xu, Y.; Zeng, Y. Annals of Surgery, 2010

Q16: External pancreatic duct stent decreases pancreatic fistula rate after : prospective multicenter randomized trial P. S. Pessaux, A.; Mariette, C.; Paye, F.; Muscari, F.; Cunha, A. S.; Sastre, B.; Arnaud, J. P.; Federation de Recherche en, Chirurgie Annals of Surgery, 2011

Q17: A prospective randomized controlled trial to compare pringle manoeuvre with hemi-hepatic vascular inflow occlusion in liver resection for hepatocellular carcinoma with cirrhosis J. S. L. Ni, W. Y.; Yang, Y.; Pan, Z. Y.; Wang, Z. G.; Liu, H.; Wu, M. C.; Zhou, W. P. Journal of Gastrointestinal Surgery, 2013

Q18: A prospective randomized trial comparing two-stage versus single-stage management of patients with gallstone disease and common bile duct stones V. K. M. Bansal, M. C.; Garg, P.; Prabhu, M. Surgical Endoscopy, 2010

Laparoendoscopic management of concomitant gallbladder stones and common bile duct stones: what is the best technique? A. A. El-Geidie Surgical , Endoscopy & Percutaneous Techniques, 2011

Laparoendoscopic rendezvous versus preoperative ERCP and laparoscopic cholecystectomy for the management of cholecysto-choledocholithiasis: interim analysis of a controlled randomized trial G. B. Tzovaras, I.; Zachari, E.; Symeonidis, D.; Zacharoulis, D.; Kapsoritakis, A.; Paroutoglou, G.; Potamianos, S. Annals of Surgery, 2012

Q19: Does Type of Pancreaticojejunostomy after Pancreaticoduodenectomy Decrease Rate of Pancreatic Fistula? A Randomized, Prospective, Dual-Institution Trial A. C. H. Berger, T. J.; Kennedy, E. P.; Sauter, P. K.; Bower-Cherry, M.; Dutkevitch, S.; Hyslop, T.; Schmidt, C. M.; Rosato, E. L.; Lavu, H.; Nakeeb, A.; Pitt, H. A.; Lillemoe, K. D.; Yeo, C. J. Journal of the American College of Surgeons, 2009

Q20: What is the best reconstruction method after distal gastrectomy for gastric cancer? M. S. A. Lee, S. H.; Lee, J. H.; Park, D. J.; Lee, H. J.; Kim, H. H.; Yang, H. K.; Kim, N.; Lee, W. W. Surgical Endoscopy, 2012

Comparison of and Roux-en-Y reconstruction after distal gastrectomy for gastric cancer: one-year postoperative effects assessed by a multi-institutional RCT M. T. Hirao, S.; Imamura, H.; Yamamoto, K.; Kurokawa, Y.; Fujita, J.; Kobayashi, K.; Kimura, Y.; Mori, M.; Doki, Y.; Osaka University Clinical Research Group for Gastroenterological, Study Annals of Surgical Oncology, 2013

Q21: Wrapping of the omental pedicle flap around esophagogastric anastomosis after esophagectomy for esophageal cancer J. G. Z. Dai, Z. Y.; Min, J. X.; Huang, X. B.; Wang, J. S. Surgery, 2011

Q22: Laparoscopic versus open approach for aortobifemoral bypass for severe aorto-iliac occlusive disease--a multicentre randomised controlled trial J. R. Tiek, P.; Sabbe, T.; D'Hont, C.; Houthoofd, S.; Daenens, K.; Fourneau, I. European Journal of Vascular & Endovascular Surgery, 2012