title: Proctologic surgery done by residents - Complications preprogrammed?
abstract: BACKGROUND
  In current literature, the participation of residents in surgical procedures is discussed as a negative outcome factor, particularly due to an increase of postoperative complications. This study investigated whether minor proctologic surgery with resident participation has a higher rate of postoperative complications.
  
  
  METHODS
  All patients who underwent an elective Milligan-Morgan hemorrhoidectomy or a resection of pilonidal sinus with rotational flap closure between January 2007 and December 2013 where included in a retrospective database. Primary outcome measure was postoperative complications rate with and without resident participation.
  
  
  RESULTS
  Forty-two (6 females: 36 males) patients underwent resection of pilonidal sinus and 61 (17 females: 44 males) patients received a hemorrhoidectomy. Twenty-two patients with pilonidal sinus and 26 patients with hemorrhoids were operated by residents. There were no differences in patient demographics. Residents need significantly more time to perform a pilonidal sinus resection (54min vs. 34.5min; P = 0.004). For hemorrhoidectomy, there were no significant differences in operative time (24min vs. 23.5min; P = 0.656). There were no significant differences in the resident and the consultant group, neither in hemorrhoidectomy nor in pilonidal sinus resection regarding readmission or outpatient visits. In the group of patients with pilonidal sinus resections, 3 patients developed a recurrence, leading to a recurrence rate of 7.1% without significant differences between the two groups (0 vs. 3; P = 0.09).
  
  
  CONCLUSIONS
  The participation of residents in proctologic procedures is not associated with higher postoperative complication rates. Residents should be exposed to proctology procedures on a regular basis, even though the operative time will be prolonged.
authors.affiliation: Department of General and Visceral Surgery, University Hospital of Frankfurt, 7, Theodor-Stern-Kai, 60590 Frankfurt, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Schreckenbach
authors.affiliation: Department of General and Visceral Surgery, University Hospital of Frankfurt, 7, Theodor-Stern-Kai, 60590 Frankfurt, Germany.
authors.forename: H
authors.initials: H
authors.lastname: El Youzouri
authors.affiliation: Department of General and Visceral Surgery, University Hospital of Frankfurt, 7, Theodor-Stern-Kai, 60590 Frankfurt, Germany.
authors.forename: W O
authors.initials: WO
authors.lastname: Bechstein
authors.affiliation: Department of General and Visceral Surgery, University Hospital of Frankfurt, 7, Theodor-Stern-Kai, 60590 Frankfurt, Germany. Electronic address: nils.habbe@kgu.de.
authors.forename: N
authors.initials: N
authors.lastname: Habbe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002983:Clinical Competence; D003107:Colorectal Surgery / Q000193:education*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D061865:Hemorrhoidectomy / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010864:Pilonidal Sinus / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D055815:Young Adult
keywords: Coloproctology; Hemorrhoidectomy, Pilonidal sinus; Resident involvement; Resident participation