Introduction Laparoscopic colorectal resections are currently the focus of colorectal training programs. Conversion rates are similar between inexperienced fellowship-trained surgeons and those with more experience. This study aimed to determine if primarily open or laparoscopoic surgical training influences type of colorectal operations performed and rates of conversion.
Method Following IRB approval, review of a prospectively maintained database was performed for all patients with a colorectal resection performed by 6 surgeons for all diagnoses from 2010–2014. Surgeons were designated as laparoscopic- or open-trained based on self-declared exposure to laparoscopy during training. Procedures were categorised by type and included if the procedure was performed both open and laparoscopic. Operative technique was recorded as laparoscopic, open, or converted; conversion was re-categorised as preemptive or reactive. Univariate analyses were performed using Chi-squared test for categorical variables. Multivariable logistic regression was performed to adjust for confounding and identify the role of variables on predicting SSI outcome.
Results 573 patients were included [mean age 57 (±17) years; 49.3% male]. Patients in the laparoscopic-trained group were older (59.8 vs. 55.9 years; p = 0.017). All other demographic variables were equivalent between groups. Laparoscopic-trained surgeons were less likely to perform proctectomy or resections involving anastomosis (p < 0.001 and p = 0.037, respectively). There was no difference in operative time between laparoscopic vs. open groups (p = 0.31). Laparoscopic-trained surgeons more likely performed procedures laparoscopically (76% vs. 65%; p = 0.018). Overall conversion was not significantly different between the groups (p = 0.374). 88% of conversions were pre-emptive and12% were reactive. Procedures with a proctectomy were more likely performed laparoscopically (80%vs. 60%; p < 0.001) and less likely to be converted (7% vs. 15%; p = 0.049). There was no difference in postoperative anastomotic leaks, intra-abdominal abscesses, or mortality between groups (p = 0.57). On multivariate analysis with the outcome of conversion, laparoscopic training was not predictive of conversion whereas procedures with an anastomosis were considered protective against conversion (OR 0.24, 0.07–0.85; P = 0.03).
Conclusion There is a difference in the types of procedures performed by surgeons who are laparoscopic-trained compared to their open-trained colleagues given that they are earlier in their career. There was no difference in conversion rates between open and laparoscopic-trained surgeons, despite an experiential difference. Larger multi-institutional studies will strengthen our findings.
Disclosure of interest None Declared.