Laparoscopic Appendectomy By Surgical Residents: Evaluating Outcomes and Learning Curve

Background
Laparoscopic appendectomy is a minimally invasive procedure that is associated with shorter hospitalisation and recovery, better pain control and less complications. However, there is a longer operating time and increased rate of intra-abdominal abscess. Studies have shown that laparoscopic appendectomy may be safely incorporated as part of the surgical training program for trainees in a teaching hospital. However, the learning curve might have an impact on the outcome of patients undergoing laparoscopic appendectomy.
Material and Methods
We aim to study the outcome of laparoscopic appendectomies done by the trainee in terms of operating time, length of hospital stay, complications and conversion rate. The learning curve of laparoscopic appendectomy in trainees will also be studied. All the consecutive cases of laparoscopic appendectomies performed as a first surgeon by 10 trainees over a period of 5 years were used in these retrospective analyses.
Results
A total of 199 with the mean age of 32.6 with suspected appendicitis underwent laparoscopic appendectomy by trainee surgeons during a 5 year period. The rate of operative complications is 7.54% (15/199). The rate of conversion to open surgery is 14.6% (29/199) with the commonest reason being adhesions. The operative duration ranged from 35 to 195 min (mean, 83.8 min) for all procedures and the average hospital stay is 3.82 days. Operative time and complication rate were reduced with increasing number of procedures performed. However length of stay and conversion rate was not reduced significantly.
Conclusion
Laparoscopic appendectomy can be safely incorporated as part of surgical training. The learning curve has an effect on operative duration and complication rate. However, the length of stay and conversion rate is not affected. Adequate supervision during initial part of the learning curve may help prevent complications.


Session: Poster

Program Number: P357

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