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Owais and colleagues have concluded that the proportion of acute appendicectomies performed by SHOs in a district hospital have remained relatively static during a period of prolific growth of laparoscopic appendicectomy.
While we agree with the authors' comments regarding the effects of changes in working patterns, we believe that the increasing use of laparoscopic appendicectomy is further eroding operative opportunities for SHOs.
We conducted a prospective study of acute appendicectomy at Leeds Teaching Hospital NHS Trust between August 2007 and February 2008.1 Overall, 117 appendicectomies were performed: 99 (85%) laparoscopic, 8 (7%) open and 10 (8%) laparoscopic conversions. All were performed by SHOs or SpRs. SHOs performed 15 (15%) of the laparoscopic appendicectomies, 5 (62%) of the open appendicectomies and 4 (40%) of the laparoscopic conversions.
In institutions embracing laparoscopic appendicectomy, the majority of appendicectomies are performed by SpRs. We believe that Owais and co-workers failed to demonstrate a reduction in SHO operative experience due to the relatively low utilisation of laparoscopic appendicectomy during the study period.
Our findings emphasise the need for the development of laparoscopic skills early in surgical training supported by expansion of college-run courses.
COMMENT ON doi 10.1308/003588408X318200 A Owais, T Wilson, N Sethi, MI Aldoori. Whose appendicectomy? Do laparoscopic appendicectomies impair SHO training? Ann R Coll Surg Engl 2008; 90: 577–80