title: [Training in laparoscopy and appendicitis].
abstract: BACKGROUND
  In order to improve laparoscopic skills, appendectomy is the most common procedure because of its high frequency and low difficulty. In spite of that, during the learning curve (each surgeon´s first 35 interventions) the incidence of complications may increase, so improvement in training means a bigger risk for some patients.
  
  
  METHODS
  We retrospectively reviewed major complications (intra-abdominal abscess, intestinal occlusion, hemorrhage) of 1,710 appendectomies performed at our service between 1997 and 2013. We divided them in three groups: open appendectomy (OA, n= 1,258), laparoscopic appendectomy during the learning curve (LDC, n= 154) and laparoscopic appendectomy after the learning curve (LAC, n= 298). In addition, we distinguish between simple appendicitis (n= 1,233) and peritonitis (n= 477).
  
  
  RESULTS
  In the OA group we detected110/1,258 major complications (8.7%), 28/154 major complications (18.2%) in the LDC group and 19/298 (6.4%) in the LAC group (p<0.05 LDC vs OA and LAC). In the simple appendicitis group, we found 13/889 major complications (1.5%) in OA, 3/115 (2.6%) in LDC group and 2/229 (0.9%) in LAC group (p= ns LDC vs OA and LAC). In the peritonitis group, 97/369 (26.3%) major complications were found in OA group, 25/39 (64%) in LDC group and 17/69 (24.6%) in LAC group (p<0.05 LDC vs OA and LAC).
  
  
  CONCLUSIONS
  Educational purpose laparoscopic appendectomy must be used in simple appendicitis cases.
authors: Servicio de Cirugía Pediátrica. Hospital Universitario Donostia.
authors: J L
authors: JL
authors: Ramos
authors: Servicio de Cirugía Pediátrica. Hospital Universitario Donostia.
authors: A
authors: A
authors: Villanueva
authors: Servicio de Cirugía Pediátrica. Hospital Universitario Donostia.
authors: J
authors: J
authors: Garay
authors: Servicio de Cirugía Pediátrica. Hospital Universitario Donostia.
authors: M
authors: M
authors: Suñol
authors: Servicio de Cirugía Pediátrica. Hospital Universitario Donostia.
authors: F
authors: F
authors: Villalón
authors: Servicio de Cirugía Pediátrica. Hospital Universitario Donostia.
authors: A
authors: A
authors: Urbistondo
authors: Servicio de Cirugía Pediátrica. Hospital Universitario Donostia.
authors: J
authors: J
authors: Jiménez
authors: Servicio de Cirugía Pediátrica. Hospital Universitario Donostia.
authors: E
authors: E
authors: Rezola
authors: Servicio de Cirugía Pediátrica. Hospital Universitario Donostia.
authors: I
authors: I
authors: Eizaguirre
keywords: Laparoscopic appendectomy; Learning curve; Major complications