Chair of Surgery of the Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, 30-705 Krakow, Poland.
Department of General and Oncological Surgery, 5th Military Clinical Hospital, 30-901 Krakow, Poland.
Medicina (Kaunas). 2024 Nov 9;60(11):1847. doi: 10.3390/medicina60111847.
: The growing number of colorectal cancer patients has highlighted the importance of surgical education in colorectal surgery. Despite the negative impact of the COVID-19 pandemic on surgical training, recent changes in the Polish surgical training program have increased the number of intestinal procedures required to be completed by residents. This study aims to assess the safety of ileostomy reversal procedures performed by surgical residents. A multicenter prospective cohort study, the LILEO study, was conducted from October 2022 until December 2023 across 20 Polish surgical departments. The study included 199 patients who underwent ileostomy reversal and were divided into two groups: 139 patients operated by specialist surgeons and 60 patients operated by surgical residents. The primary outcomes measured were postoperative complications, length of hospital stay (LOS), and 30-day reoperation rate. Secondary outcomes included the severity of perioperative complications assessed using the Clavien-Dindo classification and a focused analysis of loop ileostomy reversal outcomes. The median LOS was significantly shorter in the resident group (5.5 days vs. 6 days, < 0.05). Although the overall complication rate was lower in the resident group (21.7% vs. 33.1% in the specialist surgeon group), this difference was not statistically significant ( = 0.105). The 30-day reoperation rate was 3.3% in the resident group and 8.6% in the specialist surgeon group ( = 0.179). In terms of severity, minor complications (Clavien-Dindo grades 1 and 2) were more common in the specialist group ( < 0.05). The analysis of loop ileostomy reversals revealed no significant differences in postoperative outcomes between the two groups. Ileostomy reversal procedures performed by surgical residents under supervision are safe and feasible, with outcomes comparable to those performed only by specialist surgeons. These findings support ileostomy reversal as a valuable procedure for developing surgical residents' skills and do not negatively affect postoperative outcomes.
: 越来越多的结直肠癌患者突显了结直肠外科学术教育的重要性。尽管 COVID-19 大流行对外科培训产生了负面影响，但波兰外科培训计划的最近变化增加了住院医师需要完成的肠操作数量。本研究旨在评估外科住院医师实施回肠造口术逆转术的安全性。一项多中心前瞻性队列研究，即 LILEO 研究，于 2022 年 10 月至 2023 年 12 月在波兰的 20 个外科部门进行。该研究纳入了 199 例接受回肠造口术逆转的患者，并分为两组：由专家外科医生进行手术的 139 例患者和由外科住院医师进行手术的 60 例患者。主要结局指标是术后并发症、住院时间（LOS）和 30 天再手术率。次要结局包括使用 Clavien-Dindo 分类评估的围手术期并发症严重程度以及回肠造口术逆转结果的重点分析。住院时间在住院医师组明显缩短（5.5 天比 6 天， < 0.05）。尽管住院医师组的总并发症发生率较低（21.7%比专家外科医生组的 33.1%， = 0.105），但差异无统计学意义。住院医师组的 30 天再手术率为 3.3%，专家外科医生组为 8.6%（ = 0.179）。在严重程度方面，专家组更常见轻度并发症（Clavien-Dindo 分级 1 和 2）（ < 0.05）。两组间回肠造口术逆转的术后结果分析无显著差异。在监督下由外科住院医师进行的回肠造口术逆转是安全可行的，其结果与仅由专家外科医生进行的手术相当。这些发现支持回肠造口术逆转作为培养外科住院医师技能的有价值程序，且不会对术后结果产生负面影响。
