Schreckenbach T, El Youzouri H, Bechstein W O, Habbe N
Department of General and Visceral Surgery, University Hospital of Frankfurt, 7, Theodor-Stern-Kai, 60590 Frankfurt, Germany.
Department of General and Visceral Surgery, University Hospital of Frankfurt, 7, Theodor-Stern-Kai, 60590 Frankfurt, Germany.
J Visc Surg. 2016 Jun;153(3):167-72. doi: 10.1016/j.jviscsurg.2015.11.013. Epub 2016 Jan 25.
In current literature, the participation of residents in surgical procedures is discussed as a negative outcome factor, particularly due to an increase of postoperative complications. This study investigated whether minor proctologic surgery with resident participation has a higher rate of postoperative complications.
All patients who underwent an elective Milligan-Morgan hemorrhoidectomy or a resection of pilonidal sinus with rotational flap closure between January 2007 and December 2013 where included in a retrospective database. Primary outcome measure was postoperative complications rate with and without resident participation.
Forty-two (6 females: 36 males) patients underwent resection of pilonidal sinus and 61 (17 females: 44 males) patients received a hemorrhoidectomy. Twenty-two patients with pilonidal sinus and 26 patients with hemorrhoids were operated by residents. There were no differences in patient demographics. Residents need significantly more time to perform a pilonidal sinus resection (54min vs. 34.5min; P = 0.004). For hemorrhoidectomy, there were no significant differences in operative time (24min vs. 23.5min; P = 0.656). There were no significant differences in the resident and the consultant group, neither in hemorrhoidectomy nor in pilonidal sinus resection regarding readmission or outpatient visits. In the group of patients with pilonidal sinus resections, 3 patients developed a recurrence, leading to a recurrence rate of 7.1% without significant differences between the two groups (0 vs. 3; P = 0.09).
The participation of residents in proctologic procedures is not associated with higher postoperative complication rates. Residents should be exposed to proctology procedures on a regular basis, even though the operative time will be prolonged.
在当前文献中，住院医师参与手术操作被视为一个负面结果因素，尤其是因为术后并发症有所增加。本研究调查了有住院医师参与的小型直肠外科手术术后并发症发生率是否更高。
将2007年1月至2013年12月期间接受择期Milligan-Morgan痔切除术或采用旋转皮瓣闭合术切除藏毛窦的所有患者纳入一个回顾性数据库。主要结局指标是有和没有住院医师参与情况下的术后并发症发生率。
42例（6例女性：36例男性）患者接受了藏毛窦切除术，61例（17例女性：44例男性）患者接受了痔切除术。22例藏毛窦患者和26例痔患者由住院医师进行手术。患者人口统计学特征无差异。住院医师进行藏毛窦切除术所需时间显著更长（54分钟对34.5分钟；P = 0.004）。对于痔切除术，手术时间无显著差异（24分钟对23.5分钟；P = 0.656）。住院医师组和带教医师组在痔切除术和藏毛窦切除术后的再入院或门诊就诊方面均无显著差异。在藏毛窦切除患者组中，3例出现复发，复发率为7.1%，两组之间无显著差异（0例对3例；P = 0.09）。
住院医师参与直肠外科手术与更高的术后并发症发生率无关。住院医师应定期参与直肠外科手术，尽管手术时间会延长。
