Are we training our residents to perform open gall bladder and common bile duct operations?
BACKGROUND
In the new era of resident work hour restrictions and an emphasis on minimally invasive surgery, experience in performing open biliary surgery is diminishing. We sought to review our resident operative experience to determine if it appears adequate for a well-trained general surgeon.


METHODS
The case logs of the General Surgery, Oncology, and Trauma/Emergency General Surgery (EGS) services were reviewed for a 1-year period. All biliary procedures that included the potential for gallbladder or bile duct surgery were reviewed.


RESULTS
We performed 745 laparoscopic cholecystectomies last year on our General Surgery, Oncology, and Trauma/EGS services. Conversion to open procedure was 4.5% (16/364) on our elective services and 6% (23/381) on our Trauma/EGS services. Effective clearance of common bile duct stones performed retrograde by endoscopy and transhepatically by interventional radiology limited our residents' experience performing common bile duct surgery for stones to 13 performed laparoscopically and 10 performed open. Other operations that included open cholecystectomies and common bile duct procedures were pancreatico-duodenectomy (87), biliary bypass (22), biliary resection/reconstruction (20), hepatic lobectomy (48), sphincteroplasty and ampullectomy (6).


CONCLUSIONS
The small number of conversions from laparoscopic to open cholecystectomies and the few common bile duct explorations performed for stone disease would be inadequate to train our six categorical surgical residents to perform open cholecystectomies and common bile duct procedures without a training program that augments this by providing a strong hepato-biliary-pancreatic experience. Programs without a strong hepato-biliary-pancreatic program should review their residents' operative experience.
Schulman
Carl I
CI
DeWitt Daughtry Family Department of Surgery, University of Miami-Miller School of Medicine, Miami, Florida 33101, USA. carl@miami.edu
Levi
Joe
J
Sleeman
Danny
D
Dunkin
Brian
B
Irvin
George
G
Levi
David
D
Spector
Seth
S
Franceschi
Dido
D
Livingstone
Alan
A
D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000706:statistics & numerical data; D002763:Cholecystectomy / Q000193:education* / Q000379:methods / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic / Q000193:education / Q000706:statistics & numerical data; D042882:Gallstones / Q000601:surgery*; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration / Q000706:statistics & numerical data* / Q000639:trends; D019060:Minimally Invasive Surgical Procedures / Q000193:education / Q000706:statistics & numerical data; D010561:Personnel Staffing and Scheduling