Laparoscopic appendectomy performed by residents and experienced surgeons.
BACKGROUND
Laparoscopic appendectomy is widely performed by surgical residents, but its changing indications and outcomes have been poorly investigated. The aim of this study was to examine whether a difference exists in indications and outcomes between laparoscopic appendectomies performed by residents and those performed by experienced surgeons.


METHODS
Between 1999 and 2007, 218 laparoscopic appendectomies were performed and recorded. Data were analyzed to compare operations performed by residents with those by experienced surgeons in terms of indications for surgery and severity of disease. Moreover, laparoscopic appendectomies were thoroughly compared regarding outcomes and complications.


RESULTS
The residents had fewer conversions with laparoscopic appendectomy (8% vs 17%, P=0.04), and similar complication rates (12% vs 13%, P=0.16), compared with experienced surgeons. The median operating time was also comparable (67 minutes vs 60 minutes, P=0.23). However, patients operated on by residents had more emergencies (86% vs 70%, P=0.009), included more foreigners (27% vs 15%, P=0.03), and had intermediate to severe diseases, (81 vs 52%, P<0.001) than patients did operated on by experienced surgeons.


CONCLUSIONS
Surgical residents performed more emergency laparoscopic appendectomies on foreign patients suffering from intermediate to severe diseases compared with experienced surgeons, with comparable surgical outcomes and lower conversion rates.
Department of Oncology, Careggi Main Florence University and Regional Hospital, Italy. lapbenc@tin.it
Lapo
L
Bencini
Marco
M
Bernini
Francesco
F
Martini
Michele
M
Rossi
Cinzia
C
Tommasi
Egidio
E
Miranda
Luis Josè
LJ
Sanchez
Riccardo
R
Naspetti
Roberto
R
Manetti
Angelo
A
Ferrara
Silvia
S
Nesi
Bernardo
B
Boffi
Marco
M
Farsi
Renato
R
Moretti
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000379:methods*; D016009:Chi-Square Distribution; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D018709:Statistics, Nonparametric; D016896:Treatment Outcome