Whose appendicectomy?--Do laparoscopic appendicectomies impair SHO training?
ABSTRACT Open appendicectomy is an ideal procedure for junior surgical trainees to develop operative skills. However, in recent years, we have noticed a decline in the number of appendicectomies performed by basic surgical trainees and a shift towards increasing use of laparoscopic appendicectomy. The aim of this study was to determine whether the growing popularity of laparoscopic appendicectomy is having a detrimental impact on the training experience of SHOs.
We undertook a retrospective review of all cases of appendicectomies performed in one district hospital over a 7-year period (August 1999 to August 2006.) A standard performa was used to extract data from the original case notes of these patients relating to the operating surgeon and technique.
Data were obtained for 857 appendicectomies. Between February 2002 and July 2003, there was a significant decline in the proportion of appendicectomies performed by SHOs from 78.7% to 29.3% (P < 0.001). Either side of this decline there were no significant changes in the proportion of SHO appendicectomies. The number of appendicectomies performed laparoscopically only began to rise after February 2004, with a year-on-year increase. The number of appendicectomies performed by SHOs remained stable during this time. No laparoscopic appendicectomy was performed by an SHO.
We found no evidence that the popularisation of laparoscopic appendicectomy has contributed to the decline of appendicectomies performed by SHOs. Nevertheless, with the continual rise in popularity of this procedure, it is important to balance training opportunities for both junior and higher surgical trainees.
Full-textDOI: · Available from: Neeraj Sethi, Feb 24, 2014
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ABSTRACT: The proposed advantages of NOTES are aimed to assess the comparison with standard procedures. Complications are a major focus of its evaluation. We initiated a prospective comparison between transvaginal hybrid appendectomy versus laparoscopic appendectomy. For each, NOTES and laparoscopic appendectomy, 10 consecutive female patients participated in the study with follow-up documentation for 35 days and after 1 year. Transvaginal appendectomy was considered a non-standard medical procedure and required individual patient's consent. Pre- and postoperative gynecological examinations were performed. Questionnaire-based evaluation included issues related to quality of life in addition to objective clinical findings. The study is approved by the ethics committee of the University of Rostock. All women returned questionnaires for evaluation. Age and BMI are comparable. Overall procedure time was significantly shorter in laparoscopy. The only postoperative complication consisted of an intra-abdominal abscess after laparoscopic appendectomy. One patient of the NOTES group suffered from new abdominal pain 3 weeks postoperatively; a mini-laparoscopy showed a normal situation. Significant differences (p < 0.05) of the questionnaire-based comparison with advantages for the NOTES group were found in following items: reduced activity at day 1-14, postoperative pain at day 1, general health conditions at day 1-3 and quality of life at day 3. NOTES patients wished significantly earlier to be discharged and started significantly earlier with activities, but no differences existed after 4 weeks. Transvaginal flexible appendectomy appears to be a safe procedure performed in hybrid technique. Data from the study point to shortened recovery intervals and improved quality of life.International Journal of Colorectal Disease 12/2014; 30(2). DOI:10.1007/s00384-014-2081-x · 2.42 Impact Factor
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ABSTRACT: The laparoscopic approach for appendicectomies remains a frequent topic of debate. In this study we report the experience with laparoscopic (LA) and open appendicectomies (OA) achieved in a British University Hospital over one year where most of these operations have been conducted by junior trainees. Retrospective review of LA and OA performed at the Whipps Cross University Hospital of London (U.K.). Outcomes measured were the operating time, length of hospital stay and post-operative complications. Between January and December 2008 205 appendicectomies have been performed on adult patients. Eighty-eight per cent of the procedures were conducted by junior surgeons. The operating time was significantly shorter for the OA vs. LA patients (55 +/- 26.8 vs. 83 +/- 26.9 min, p < 0.01). The hospital stay confirmed a significant advantage for LA (2.2 vs. 3.7 days, p = 0.02). No significant differences were present among techniques for the overall morbidity, post-operative intra-abdominal abscesses and rate of readmissions. Under adequate supervision LA can be safely performed by junior surgeons and reduces the hospital stay.European review for medical and pharmacological sciences 05/2012; 16(5):687-90. · 0.99 Impact Factor
Article: Offene Appendektomie[Show abstract] [Hide abstract]
ABSTRACT: Die akute Appendizitis ist mit über 130.000 Appendektomien im Jahr der häufigste viszeralchirurgische Notfalleingriff in Deutschland. Die Frage nach dem Operationsverfahren muss daher in regelmäßigen Abständen diskutiert werden. Laparoskopische Operationen werden mittlerweile von allen chirurgischen Abteilungen in Deutschland angeboten. Besonders in Krankenhäusern mit Schwerpunkt in der minimal-invasiven Chirurgie wird die laparoskopische Appendektomie (LA) als Standardverfahren angegeben. Knapp 30Jahre nach Einführung der LA entsteht der Eindruck, dass nur noch in wenigen Fällen eine offene Appendektomie (OA) durchgeführt wird. Tatsächlich wurden 2006 in Deutschland aber 46% aller Appendektomien konventionell durchgeführt. Dieser hohe Prozentsatz belegt, dass die OA nach wie vor das Standardverfahren in vielen chirurgischen Abteilungen in Deutschland ist. Anhand der Ergebnisse der Literatur gibt es bestimmte Situationen, in denen die OA vorteilhaft sein kann. Kleinkinder (unter 5Jahre) haben durch ihre kleine Abdominalhöhle schwierige Grundvoraussetzungen für eine LA, sodass meistens eine OA als das Verfahren der Wahl gilt. In der Schwangerschaft birgt eine OA ein niedrigeres Risiko für den Fetus als die LA. Die Kostenanalyse zeigt, dass die OA die finanziell günstigere Methode für das Krankenhaus (Materialkosten) ist, während die LA durch den früheren Wiedereintritt der Patienten in die Arbeitswelt die volkswirtschaftlich bessere Variante ist. Aufgrund der schnellen Rekonvaleszenz der Patienten nach einer Appendektomie sind die Unterschiede der beiden Verfahren nur marginal. In verschiedenen Subgruppenanalysen zeigen sich aber Vorteile für die einzelnen Verfahren. Die möglichen Subgruppen, die von einer OA profitieren könnten, werden hier besprochen. Acute appendicitis is the most common emergency visceral surgical procedure in Germany with 130,000 appendectomies. The question of which operational procedure should be used must therefore be discussed at regular intervals. In many centers of minimal invasive surgery, laparoscopic appendectomy (LA) is the standard procedure. Nearly 30 years after introduction of LA, it is believed that open appendectomy (OA) is needed only on rare occasions, but the actual percentage of OAs carried out in 2006 was 46% of all appendectomies. This high percentage documents that OA is still the standard procedure in many German hospitals. A review ofthe literature shows that there are still some situations in which OA is superior to LA. Infants younger than 5 years old have a more difficult basic requirement for LA due to the small abdominal cavity, therefore OA is the procedure of choice in most cases. During pregnancy OA has a lower risk for the fetus than LA. Cost analyses show that OA is less expensive for the hospital in material costs, whereas LA is the better economic choice due to an earlier return to work. In summary, there are only marginal differences between the two procedures since both offer a fast patient recovery. Advantages in favor of both LA and OA exist in subgroup analyses and the possible subgroups that can benefit from OA are discussed in this article.Der Chirurg 07/2009; 80(7):602-607. DOI:10.1007/s00104-009-1683-2 · 0.52 Impact Factor