Can Ileostomy Reversal Be Safely Performed by Surgical Residents?
Michał Kisielewski, Magdalena Pisarska-Adamczyk, Natalia Dowgiałło-Gornowicz, Łukasz Nawacki, Wojciech Serednicki, Mateusz Wierdak, Jerzy Wilczek, Kamil Safiejko, Marcin Juchimiuk, Marian Domurat, Jacek Pierko, Mateusz Mucha, Wojciech Fiedorowicz, Michał Wysocki, Maurycy Ladziński, Michał Zdrojewski, Tomasz Sachańbiński, Tomasz Wojewoda, Victoria Chochla, Karol Tkaczyński, Michał Jankowski, Wojciech M Wysocki, LILEO Study Group
Author Information
Michał Kisielewski: Chair of Surgery of the Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, 30-705 Krakow, Poland. ORCID
Magdalena Pisarska-Adamczyk: Department of General and Oncological Surgery, 5th Military Clinical Hospital, 30-901 Krakow, Poland. ORCID
Natalia Dowgiałło-Gornowicz: Department of General, Minimally Invasive and Elderly Surgery, University of Warmia and Mazury, 10-719 Olsztyn, Poland. ORCID
Łukasz Nawacki: Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland. ORCID
Wojciech Serednicki: 2nd Department of General Surgery, Jagiellonian University, 30-688 Krakow, Poland. ORCID
Mateusz Wierdak: 2nd Department of General Surgery, Jagiellonian University, 30-688 Krakow, Poland.
Jerzy Wilczek: Department of Oncological Surgery, Specialist Hospital, 36-200 Brzozow, Poland.
Kamil Safiejko: Colorectal Cancer Unit, Maria Skłodowska-Curie Białystok Oncology Center, 15-027 Białystok, Poland. ORCID
Marcin Juchimiuk: Colorectal Cancer Unit, Maria Skłodowska-Curie Białystok Oncology Center, 15-027 Białystok, Poland.
Marian Domurat: Colorectal Cancer Unit, Maria Skłodowska-Curie Białystok Oncology Center, 15-027 Białystok, Poland.
Jacek Pierko: Colorectal Cancer Unit, Maria Skłodowska-Curie Białystok Oncology Center, 15-027 Białystok, Poland.
Mateusz Mucha: Colorectal Cancer Unit, Maria Skłodowska-Curie Białystok Oncology Center, 15-027 Białystok, Poland.
Wojciech Fiedorowicz: Colorectal Cancer Unit, Maria Skłodowska-Curie Białystok Oncology Center, 15-027 Białystok, Poland.
Michał Wysocki: Department of General Surgery and Surgical Oncology, Ludwik Rydygier Memorial Hospital, 31-826 Krakow, Poland. ORCID
Michał Zdrojewski: Oncological Surgery Clinic, MSWiA Hospital, 10-228 Olsztyn, Poland.
Tomasz Sachańbiński: Oncological Surgery Department with a Sub-Department of Breast Diseases, Tadeusz Koszarowski Oncology Centre, 45-061 Opole, Poland.
Tomasz Wojewoda: Chair of Surgery of the Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, 30-705 Krakow, Poland.
Victoria Chochla: Chair of Surgery of the Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, 30-705 Krakow, Poland.
Karol Tkaczyński: Department of Surgical Oncology, Oncology Center, Prof. Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland. ORCID
Michał Jankowski: Department of Surgical Oncology, Oncology Center, Prof. Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland. ORCID
Wojciech M Wysocki: Chair of Surgery of the Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, 30-705 Krakow, Poland. ORCID
: The growing number of colorectal cancer patients has highlighted the importance of surgical education in colorectal surgery. Despite the negative impact of the COVID-19 pandemic on surgical training, recent changes in the Polish surgical training program have increased the number of intestinal procedures required to be completed by residents. This study aims to assess the safety of ileostomy reversal procedures performed by surgical residents. A multicenter prospective cohort study, the LILEO study, was conducted from October 2022 until December 2023 across 20 Polish surgical departments. The study included 199 patients who underwent ileostomy reversal and were divided into two groups: 139 patients operated by specialist surgeons and 60 patients operated by surgical residents. The primary outcomes measured were postoperative complications, length of hospital stay (LOS), and 30-day reoperation rate. Secondary outcomes included the severity of perioperative complications assessed using the Clavien-Dindo classification and a focused analysis of loop ileostomy reversal outcomes. The median LOS was significantly shorter in the resident group (5.5 days vs. 6 days, < 0.05). Although the overall complication rate was lower in the resident group (21.7% vs. 33.1% in the specialist surgeon group), this difference was not statistically significant ( = 0.105). The 30-day reoperation rate was 3.3% in the resident group and 8.6% in the specialist surgeon group ( = 0.179). In terms of severity, minor complications (Clavien-Dindo grades 1 and 2) were more common in the specialist group ( < 0.05). The analysis of loop ileostomy reversals revealed no significant differences in postoperative outcomes between the two groups. Ileostomy reversal procedures performed by surgical residents under supervision are safe and feasible, with outcomes comparable to those performed only by specialist surgeons. These findings support ileostomy reversal as a valuable procedure for developing surgical residents' skills and do not negatively affect postoperative outcomes.
