Controversial issues of diagnosis and multi-stage surgical treatment in patients with extraperitoneal rectal wounds

AIM: to assess the adherence of surgeons to various methods of diagnosis and surgical treatment of patients with extraperitoneal rectal wounds at different levels of medical care.

MATERIALS AND METHODS: in October 2024, an observational cross-sectional study for patients with extraperitoneal rectal wounds was done using an anonymous questionnaire online, in which 75 surgeons took part. Respondents were divided into four groups depending on the characteristics of the medical evacuation stage. Inclusion criteria: the respondent surgeon must have experience in providing surgical care at one of the listed levels of medical care. Exclusion criteria: the respondent has no experience in providing surgical care at the listed levels of medical care.

RESULTS: a survey of surgeons at various levels of medical care revealed a lack of or low internal consistency in most of the respondents’ answers at each level of medical care. A moderate degree of consistency was achieved when answering questions about the method and purposes of performing routine drainage of pelvic cellular spaces. In the answers to the question about the sequence of performing surgical techniques for extraperitoneal injuries of the rectum, the AC1 Gvet coefficient approaches the mean degree of agreement (0.383 (95% confidence interval: 0.119; 0.647)).

CONCLUSION: one of the options for unified approach to providing surgical care for extraperitoneal rectal wounds is to conduct a study using by the Delphi method with the involvement of a group of experts, followed by the development and implementation, based on a consensus decision, of algorithms for the treatment of this type of injury at the stages of medical evacuation.

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