Purpose To delineate the learning curve (LC) for laparoscopic appendectomy (LA) performed by residents according to seniority in training.
Methods Between October 2015 and November 2016, 150 patients underwent LA by three residents (in their first, second, and third year of training) under supervision. The patients were non-randomly assigned to each resident. The data were reviewed and analyzed retrospectively from prospectively collected database. The perioperative outcomes were compared between the three residents including operation time, complication, conversion, and so on. The LCs were evaluated by the moving average method and cumulative sum control chart (CUSUM) for operation time and surgical completion.
Results Baseline characteristics and perioperative outcomes were similar except for age and location of the appendix among the three groups. Operation time was not different among the three residents (43.9, 45.3, and 48.4 min for A, B, and C, respectively). The moving average method for operation time showed a decreasing tendency for all residents. CUSUM for operation time showed that the peak points occurred at the 24th, 18th, and 31st cases for resident A, B, and C, respectively. In terms of surgical failure, residents A, B, and C reached steady states after the 35th, 11th, and 16th cases, respectively. Perforation of the appendix base was the only risk factor for surgical failure.
Conclusion The LC for LA by residents was 11-35 cases according to multidimensional statistical analyses. The accumulation of surgical experience of residents might affect the LC, especially for surgical completion rather than for operation time.
Citations
Citations to this article as recorded by
Comparative analysis of surgical outcomes of laparoscopic appendectomy performed by six surgeons with different subspecialties: a retrospective cohort study using risk-adjusted cumulative summation Ji Hyeong Song, Inyoung Na, Song-Yi Kim, Youn Ju Lee, Sun Jong Han, Sang Il Youn, Sa-Hong Min, Jin Soo Kim Annals of Surgical Treatment and Research.2025; 109(3): 207. CrossRef
The Influence of Surgical Teaching on Laparoscopic Cholecystectomy Outcomes: A Retrospective Propensity Score-Matched National Cohort Study Joana Rodrigues Ribeiro, André Silva Alves, Pascal Probst, Samuel A. Käser, Christian Toso, Beat Moeckli Journal of Surgical Education.2025; 82(11): 103744. CrossRef
Systematic review and meta-analysis comparing perioperative outcomes of emergency appendectomy performed by trainee vs trained surgeon Theophilus TK. Anyomih, Thomas Jennings, Alok Mehta, J Robert O'Neill, Ioanna Panagiotopoulou, Stavros Gourgiotis, Elizabeth Tweedle, John Bennett, R Justin Davies, Constantinos Simillis The American Journal of Surgery.2023; 225(1): 168. CrossRef
Graded operative autonomy in emergency appendectomy mirrors case-complexity: surgical training insights from the SnapAppy prospective observational study Nathalie Young, Rebecka Ahl Hulme, Maximilian Peter Forssten, Lewis Jay Kaplan, Thomas Noel Walsh, Yang Cao, Shahin Mohseni, Gary Alan Bass, Alan Biloslavo, Hayato Kurihara, Isidro Martinez-Casas, Jorge Pereira, Arvid Pourlotfi, Éanna J. Ryan, Matti Tolon European Journal of Trauma and Emergency Surgery.2023; 49(1): 33. CrossRef
Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper Nicola de’Angelis, Francesco Marchegiani, Carlo Alberto Schena, Jim Khan, Vanni Agnoletti, Luca Ansaloni, Ana Gabriela Barría Rodríguez, Paolo Pietro Bianchi, Walter Biffl, Francesca Bravi, Graziano Ceccarelli, Marco Ceresoli, Osvaldo Chiara, Mircea Chiri World Journal of Emergency Surgery.2023;[Epub] CrossRef
How does the number of training years in pediatric surgery affect appendectomy outcomes? Carlos Delgado-Miguel, Miriam Miguel-Ferrero, María San Basilio, Carla Ramírez, Juan Camps, Francisco Hernández Oliveros Pediatric Surgery International.2023;[Epub] CrossRef
Clinical outcomes of locking polymeric clip for laparoscopic appendectomy in patients with appendicitis: a retrospective comparison with loop ligature Seokwon Kim, Byong Ho Jeon, Sang Sik Cho, Ui Sup Shin, Sun Mi Moon Annals of Coloproctology.2022; 38(2): 160. CrossRef
Laparoscopic appendicectomy without the use of disposable materials - a low-cost alternative - 1,552 cases operated in 20 years CARLOS EDUARDO DOMENE, PAULA VOLPE, ANDRÉ VALENTE SANTANA Revista do Colégio Brasileiro de Cirurgiões.2022;[Epub] CrossRef
Learning curve in laparoscopic appendectomy: training strategy of laparoscopic surgery Hyung Ook Kim Annals of Coloproctology.2022; 38(3): 276. CrossRef
Factors Influencing the Difficulty and Need for External Help during Laparoscopic Appendectomy: Analysis of 485 Procedures from the Resident-1 Multicentre Trial Stefano Cioffi, Andrea Spota, Michele Altomare, Stefano Granieri, Roberto Bini, Francesco Virdis, Federica Renzi, Elisa Reitano, Osvaldo Chiara, Stefania Cimbanassi Journal of Personalized Medicine.2022; 12(11): 1904. CrossRef
Impact of COVID-19 on the care of acute appendicitis: a single-center experience in Korea Chang Woo Kim, Suk-Hwan Lee Annals of Surgical Treatment and Research.2021; 101(4): 240. CrossRef
Purpose Stoma takedown is a frequently performed procedure with considerable postoperative morbidities. Various skin closure techniques have been introduced to reduce surgical site infections. The aim of this study was to assess postoperative outcomes after stoma takedown during a long-term follow-up period.
Methods Between October 2006 and December 2015, 84 consecutive patients underwent a colostomy or ileostomy takedown at our institution. Baseline characteristics and perioperative outcomes were analyzed through retrospective reviews of medical records.
Results The proportion of male patients was 60.7%, and the mean age of the patients was 59.0 years. The overall complication rate was 28.6%, with the most common complication being prolonged ileus, followed by incisional hernia, anastomotic leakage, surgical site infection, anastomotic stenosis, and entero-cutaneous fistula. The mean follow-up period was 64.3 months. The univariate analysis revealed no risk factors related to overall complications or prolonged ileus.
Conclusion The postoperative clinical course and long-term outcomes following stoma takedown were acceptable. Stoma takedown is a procedure that can be performed safely.
Citations
Citations to this article as recorded by
Multidisciplinary management of a patient with vesicosigmoid fistula and multisystem diseases undergoing stoma reversal: a case report Jian Yang, Li Zhang, Ke Zeng BMC Surgery.2026;[Epub] CrossRef
Complicated diverticulitis: Diagnostic precision and surgical solutions in a patient with chronic kidney disease Sharon L. Hsieh, Nathaniel Grabill, Mena Louis, Bradley Kuhn Radiology Case Reports.2025; 20(1): 346. CrossRef
Comparing Surgical Site Infection Rate Between Primary Closure and Rhomboid Flap After Stoma Reversal Che-Ming Chu, Chih-Cheng Chen, Yu-Yao Chang, Kai-Jyun Syu, Shih-Lung Lin Annals of Plastic Surgery.2024; 92(1S): S33. CrossRef
TIMING OF THE STOMA REVERSAL, WHAT IS THE SAFE PERIOD?: A RETROSPECTIVE OBSERVATIONAL STUDY GIRIDHAR ASHWATH, ESHWAR KATHIRESAN MANASIJAN, ANTHONY P ROZARIO Asian Journal of Pharmaceutical and Clinical Research.2024; : 181. CrossRef
Diverting ileostomy in benign colorectal surgery: the real clinical cost analysis F. Ascari, G. Barugola, G. Ruffo Updates in Surgery.2024; 76(5): 1761. CrossRef
Laparoscopic versus open Hartmann reversal: a propensity score matching analysis Li Tan, Xiao-Yu Liu, Bin Zhang, Lian-Lian Wang, Zheng-Qiang Wei, Dong Peng International Journal of Colorectal Disease.2023;[Epub] CrossRef
Defunctioning stoma in anterior resection for rectal cancer does not impact anastomotic leakage: a national population-based cohort study Eihab Munshi, Marie-Louise Lydrup, Pamela Buchwald BMC Surgery.2023;[Epub] CrossRef
Surgical Site Infection After Stoma Reversal: A Comparison Between Linear and Purse-String Closure Muhammad Awais Khan, Khurram Niaz, Shahzeb Asghar, Maaz A Yusufi, Mohtamam Nazir, Syed Muhammad Ali, Aryan Ahmed, Akeel Ahamed Salahudeen, Talha Kareem Cureus.2023;[Epub] CrossRef
Factors Predicting the Reversal of Hartmann’s Procedure Ömer Yalkın, Fatih Altıntoprak, Mustafa Yener Uzunoğlu, Yasin Alper Yıldız, Muhammet Burak Kamburoğlu, Necattin Fırat, Fehmi Çelebi, Mihajlo Jakovljevic BioMed Research International.2022;[Epub] CrossRef