A. Bickel et al., LAPAROSCOPIC CHOLECYSTECTOMY FOR ACUTE CHOLECYSTITIS PERFORMED BY RESIDENTS IN SURGERY - A RISK FACTOR FOR CONVERSION TO OPEN LAPAROTOMY, Journal of laparoendoscopic & advanced surgical techniques-Part A, 8(3), 1998, pp. 137-141
Recent observations point to a seemingly high conversion rate to lapar
otomy in cases of laparoscopic operations for acute cholecystitis that
are performed by surgical residents. The purpose of the study is to e
valuate those observations. In a retrospective nonrandomized study, co
nducted between February 1992 and December 1997, 285 laparoscopic oper
ations for acute cholecystitis were analyzed. Those performed by atten
ding surgeons were compared with those performed by residents assisted
by attending surgeons. Of 123 laparoscopic operations performed by la
paroscopic surgeons between Feburary 1992 and September 1995, 20.3% we
re converted to laparotomy, compared with 41.3 % of the 29 operations
performed by the residents (p < 0.017), with no increase in complicati
on rate. Factors like male sex, duration of upper abdominal pain, and
severity of the inflammatory process were not significantly different
in both groups. The residents' seniority did not influence the convers
ion rate. A constant and significant decrease in conversion rate to la
parotomy was observed over the course of time, as the study proceeded
to December 31, 1997 (p < 0.01). We conclude that the performance of d
ifficult laparoscopic cholecystectomy by residents with the assistance
of attending surgeons is feasible, but carries a higher conversion ra
te to laparotomy for reasons that are not entirely clear. The possibil
ity of a learning curve of the residents is suggested.