Six of the Best, Colorectal 19

• Published in: British journal of surgery Vol. 89; no. S1; p. 58
• Main Authors: Katory, M., Goodfellow, P., Fletcher, D., Adam, I.J., Shorthouse, A.J.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 2002
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1046/j.1365-2168.89.s.1.16_3.x

Aims: The ACGBI have identified four index procedures for training and suggests the minimum numbers to achieve competency. For fistula‐in‐ano (FIA) surgery this number is 30. No recommendation of what proportion should be ‘complex’ FIA has been made. The central unit in our region has a regional referral practice for complex FIA. This provides an ideal opportunity to assess exposure of HSTs to complex FIA. Method: We reviewed the notes of all patients referred for FIA surgery over an 18‐month period using the unit's prospective audit databse. Fistulas were analysed using Parks' classification. 1 Subcutaneous (simple) 2 Intersphincteric (simple) 3 Intersphincteric + abscess or secondary track above the dentate line (complex) 4 Transsphincteric at the dentate line or above (complex) 5 Transsphincteric + abscess or secondary track (complex) 6 Supra‐sphincteric (complex) 7 Extra‐sphincteric (complex) Results: Eighty‐five operations for FIA were performed. Twenty‐nine of 58 patients with simple FIA (50%) and 13/27 patients with complex FIA (48%) were operated on by higher surgical trainees. An average of 57 FIA operations per year were performed; 39 simple and 18 complex. Trainees performed 19 and 9 of these respectively. Conclusion: Over a period of 1 year this colorectal unit provided 93% of the minimum number of FIAs for trainees to achieve competency levels as defined by the ACPGBI. However, most were simple with complex fistulas requiring significant consultant input. The competency of colorectal HSTs required to manage ‘complex’ FIA as independent practitioners remains uncertain without the availability of more detailed guidelines on what constitutes a complex FIA and the degree of exposure to these procedures during training.