Laparoscopic appendectomy as a teaching procedure: experiences with 1197 patients in a community hospital

Abstract

Since laparoscopic procedures have become more common, resident surgeons have to learn complex laparoscopic skills at an early stage of their career. The aim of this study was to compare the short-term clinical outcome parameters of laparoscopic appendectomy (LA) performed by resident surgeons (RS) or attending surgeons (AS). A total of 1197 LA and 57 open appendectomies were performed in a Swiss community hospital between 1999 and 2009. RS performed 684 operations. Parameters including the duration of the operation and hospital stay, intraoperative complications, surgical reinterventions, and a 30-day morbidity and mortality were observed. The mean age of the patients was 35.6 ± 18.17 years. The duration of the operation was longer (61.34 ± 25.73 min [RS] vs. 53.65 ± 29.89 [AS] min; p = 0.0001), but the hospital stay was shorter, in patients treated by RS (3.92 ± 2.61 days [RS] vs. 4.87 ± 3.23 [AS] days; p = 0.0001). The rate of intraoperative complications was not significantly different between the two groups (1.02 % [RS] vs. 0.8 % [AS]; p = 0.6). The need for surgical reintervention (0.6 % [RS] vs. 2.5 % [AS]; p = 0.005) and the 30-day morbidity were higher in patients treated by AS (3.7 % [AS] vs. 1.8 % [RS]; p = 0.04). There was no postoperative mortality. Under appropriate supervision, surgical residents are able to perform LA with results comparable to those of experienced surgeons.