Laparoscopic appendicectomy: an operation for all trainees but does the learning curve continue into consultanthood?

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Abstract

Background:

In public hospitals, the work-up and surgery for patients with appendicitis is predominantly performed by surgical registrars, whereas in private hospitals, it is performed by consultants. This study aims to demonstrate the difference, if any, in the demographics, work-up, management and complication rate of patients in these two groups.

Methods:

This was a retrospective review of all patients who underwent laparoscopic appendicectomy at a major public hospital and major private hospital over the same 13 months. Data included demographics, admission details, work-up, length of stay, time to surgery, histology and complications. Fisher's exact test and the unpaired t-test were performed to look at the statistical difference between these two groups.

Results:

Total laparoscopic appendicectomies were 164 (public) and 105 (private). Median waiting times to operation were 13 and 9.5 h, respectively. Histological findings of appendicitis/neoplasia/normal appendix were 83.5/3.0/13.4% and 81.9/1.9/16.2%. Histological findings of gangrene or perforation were 26.2% and 11.6% (P = 0.0081). The proportion of those who had surgery more than 24 h after admission was 12.2% and 4.8% (P = 0.0517). Rates of pelvic collection were 1.2% and 1.9% (P = 0.6448), wound infection rates were 2.4% and 1.9% (P = 1) and overall complication rates were 7.3% and 8.6% (P = 0.8165). Mean operative time was 49.79 min for consultants and 67.98 min for registrars (P < 0.0001).

Conclusion:

Consultants are faster at laparoscopic appendicectomies than registrars. A consultant lead service in a private hospital has earlier operation times and less patients ending up with gangrenous or perforated appendicitis but does not alter complication rates.

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