Original researchAdvanced laparoscopic fellowship training decreases conversion rates during laparoscopic cholecystectomy for acute biliary diseases: A retrospective cohort study

- Acute biliary pathology may increase morbidity during laparoscopic cholecystectomy.
- We examine the impact of advanced laparoscopic fellowship-trained surgeons on surgical morbidity.
- The conversion rate for the fellowship-trained group was significantly lower than for the non-fellowship trained group.
- Laparoscopic fellowship training may shorten hospitalization among patients presenting with acute biliary pathology.

Introduction: Acute biliary pathology is a risk factor for conversion to open surgery and increased surgical morbidity during laparoscopic cholecystectomy (LC). The purpose of our study was to examine the impact of an advanced laparoscopic fellowship-trained surgeon on risks of conversion, surgical morbidity, and postoperative complications in this patient population. Methods: Of 1382 patients who underwent an LC from January 2008 to August 2011, 592 patients were diagnosed with an acute biliary process and were included in the study. Patients were divided into two groups; those operated on by an advanced laparoscopic fellowship-trained surgeon (N = 237), and those operated on by a non-laparoscopic fellowship-trained surgeon (N = 355). The primary end-points were conversion rates and surgical morbidity. The secondary end-point was operative time. Results: Fellowship-trained surgeons were more likely to perform IOC (57%) versus non-fellowship trained surgeons (20%) (p < 0.0001). The conversion rate for the fellowship-trained group was significantly lower than for the non-fellowship trained group (1.7% vs 8.5%, p = 0.0004). The intraoperative and postoperative complication rates for the fellowship-trained group were not significantly different. The operative time was slightly longer in the non-fellowship trained group compared to the fellowship-trained group (104 min vs 111 min, p = 0.04). Discussion: Our data demonstrate that advanced laparoscopic fellowship training decreases conversion rates of laparoscopic cholecystectomy for acute biliary pathology. Moreover, given the lower conversion rates, patients may have experienced shorter hospitalizations. Conclusions: Formal advanced laparoscopic fellowship training may decrease length of stay among patients presenting with acute biliary pathology who undergo laparoscopic cholecystectomy.