Laparoscopic appendectomy by surgical trainees at a public teaching hospital in Cape Town, South Africa: A retrospective, observational study

Abstract

[Accepted Research Article]

Background: The uptake of laparoscopic appendectomy (LA) for acute appendicitis is variable in resource-limited settings despite abundant literature showing improved patient outcomes. In South Africa, surgical trainees conduct most emergency operations unsupervised. The objectives of this study were to describe uptake and trainee supervision of LA at a teaching hospital in a resource-limited setting.

Methods: A retrospective, observational study from 1^st January 2013 to 31^st December 2015 was conducted at New Somerset Hospital, a public teaching hospital in Cape Town, South Africa. Participants included were patients undergoing appendectomy for acute appendicitis. Factors associated with the choice of LA compared with open appendectomy among surgical trainees and surgical outcomes were measured.

Results: Two hundred and seventy-six appendectomies (62%) were attempted laparoscopically, with 225 (84%) completed LA and 51 (19%) converted to open appendectomy (OA). The proportion of cases completed laparoscopically significantly increased from 29% in 2013 to 68% in 2015 (p<0.001). Trainees were involved in all appendectomies, unsupervised in 85% of cases. Factors significantly associated with OA were male gender, generalized peritonitis, heart rate, and unsupervised trainees (p<0.005). Unsupervised trainees were not associated with longer length of stay (p=0.352) or conversion (p=0.506).

Conclusions: LA was the most common operation for acute appendicitis and the majority were performed by unsupervised trainees in this setting. Establishment of a LA policy utilizing a change management approach with buy-in from all stakeholders is critical to scaling up LA at teaching hospitals and could be a potential starting point to establish minimally invasive surgery in resource-limited settings.