The decline of training in open biliary surgery: effect on the residents' attitude toward bile duct surgery.
BACKGROUND
After more than a decade of growth for laparoscopic cholecystectomy and decline in open cholecystectomy, the impact on the training of resident's in other open biliary operations can be analyzed quantitatively.


METHODS
The national operative statistics for residents' operations from 1988 to 2001 (data in the public domain) were analyzed by regression analysis to establish trends and to calculate the rate of change. For laparoscopic biliary operations, the changes in laparoscopic and open operations over time and the number of operations per trainee each year were used to measure the growth of a laparoscopic operation and to predict future trends. A survey of attitude, management algorithm, and self-confidence for coping with unexpected events in laparoscopic cholecystectomy also was conducted for senior residents and recent graduates.


RESULTS
In 2001, open cholecystectomy decreased to 28%, open common duct exploration to 27%, sphincteroplasty to 20%, of 1988 (baseline year) levels. Cholecystostomy and choledochoenteric bypass decreased to 70% and 75%, respectively. The decline began before the era of laparoscopic cholecystectomy, but accelerated after its introduction. Many of the recent graduates surveyed in one program indicated a preference for a nonsurgical, mainly endoscopic, approach for all bile duct conditions, but also for the assistance of senior surgeons in the operative management of unexpected events.


CONCLUSIONS
The popularity of noninvasive therapy in biliary surgery significantly reduced the resident's exposure to open biliary surgery, adversely affecting their confidence in the management of unexpected events encountered during laparoscopic operations. Supplemental and remedial education measures must be instituted in training programs.
Chung
R S
RS
Department of Surgery, Huron Hospital, Cleveland Clinic Health System, 13951 Terrace Road, E. Cleveland, Ohio 44112, USA.
Wojtasik
L
L
Pham
Q
Q
Chari
V
V
Chen
P
P
D001291:Attitude of Health Personnel; D001662:Biliary Tract Surgical Procedures / Q000193:education*; D003194:Computer-Assisted Instruction; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data* / Q000639:trends; D011159:Population Surveillance; D014481:United States; D014584:User-Computer Interface