Laparoscopic appendicectomy: a safe option for basic laparoscopic training

Abstract

Background: Laparoscopic appendicectomy has advantages over open surgery in terms of complications, postoperative pain and the length of hospital stay. It is considered as a preferred basic laparoscopic procedure for surgical trainees based on the studies performed at teaching hospitals. Objective:The aim of this study was to determine whether laparoscopic appendicectomy can safely be carried out by surgical trainees in peripheral hospitals.Methods: A retrospective analysis was conducted at a base hospital in Uva province of Sri Lanka including all laparoscopic appendicectomies performed from July 2018 to December 2018. Duration of procedure, complications, postoperative pain, and duration of hospital stay were compared between the surgeries performed by surgeon (group A) and by a supervised trainee (group B).Results: 53 laparoscopic appendicectomies, 15 (28.3%) were included in group A and 38 (71.7%) were included in group B. Demographics including age, intraoperative findings and histology were comparable between two groups. There were no significant differences observed between group A and B for the duration of procedure (34.67 min vs. 41.18 min, p = 0.30), deep surgical site infections (0 vs. 2.6%, p = 1.0), median postoperative pain score (1 vs 1, p = 0.23) and duration of hospital stay (2.27 days vs. 2.58 days, p = 0.11). However, group B had a higher conversion rate to open surgery compared to group A (5% vs. 0). Conclusion:Laparoscopic appendicectomy is a safe procedure for supervised trainees to perform in peripheral hospital setting.