Safety of Laparoscopic Appendectomy performed by Residents

Introduction: Laparoscopic appendicetomy (LA) is becoming routinely performed by Italian surgical residents, but specific outcomes have been poorly investigated, as compared to those carried out by experienced surgeons. Methods: Between 1999 and 2007, 474 unselected patients underwent surgery for appendicitis in our Division. Of these, 218 (46%) were approached by laparoscopy firstly. Patients operated by Surgical Residents (RS, n°91) were matched with those operated by Experienced Surgeons (ES, n°127). Demographics, periopeoperative parameters, including conversions and complications were compared among the two groups. Results: Age, gender and ASA score were all well matched in the two groups. The proportion of urgent operation was higher among RS (86% vs. 72%, p=0.009). The proportion of operations carried out for subacute/incidental or complicated (perforated with abscess) appendicitis was higher among ES, while RS operated more oedhematous/phlegmonous appendicitis (p<0.00). However, the incidence of appendicitis with retrociecal position, drainages left, additional procedures and operative time were very comparable. Conversions to open surgery were more frequent among ES (17% vs. 8%, p=0.04). Postoperative complications, including abscesses, wound infections and other general complications, and length of stay, were also equal. Discussion: Italian residents have few possibility to gain sufficient skills in complex laparoscopic procedures. However, LA is a safe and feasible operation in the hands of Italian trainees. Interestingly, RS had a lower conversions’ rate, probably due to patients’ selection.