Objective assessment of trainee operative experience in a tertiary hepatobiliary unit.

INTRODUCTION: Indicative numbers for completion of training (CCT) in the UK requires 35 upper Gastrointestinal/Hepatobiliary resections and 110 (50 non HPB trainees) cholecystectomies. We aim to identify whether the training experience in our centre meets the CCT requirements for hepatobiliary surgery and compare training opportunities to those in international fellowships. METHODS: We retrospectively reviewed our hospital's operating theatre database for all patients undergoing a liver or gallbladder resection between January 2008 and July 2015 using corresponding procedural codes and consultant name. The cohort was categorized based on case and primary operating surgeon. The training grade of the surgeon was split into junior registrar (ST3/5), senior registrar (ST6/8) and senior fellow (post-CCT). RESULTS: Over a 7.5 year period we performed 2301 hepatobiliary procedures. The senior fellows and senior registrars performed a median of 42 liver resections (range 15-94) and 77 (range 35-110) cholecystectomies as the primary operator in any given 12 month period. The academic output for the unit was 104 over this period, with a median publication rate of 1.34 papers/trainee in any given 12 months. 15/16 senior fellow/senior registrars went on to secure substantive hepatobiliary consultant posts. CONCLUSIONS: Our centre delivers in excess of the required operative volume and clinical competencies for CCT in Hepatobiliary surgery in a 12 month period and exposure of trainees to operative experience is commensurate to the best performing international fellowships.

[Helicobacter pylori infection and the surgically treated stomach]. / Hélicobacter pylori et estomac opéré.

In 38 patients who had been operated for peptic ulcer (32) or gastric cancer (6), we performed upper GI endoscopy with biopsies. HP was found in the mucosa in 8 out of 10 patients with highly selective vagotomy, 5 out of 11 patients with gastrectomy for ulcer, 6 out of 11 patients with vagotomy-pyloroplasty and in only 1 case out of 6 with gastrectomy for cancer. These results are in agreement with other publications. Bilio-pancreatic reflux into the stump probably explains why HP was found in only 50% of cases with suppression of pyloric function, compared with 80% after highly selective vagotomy. Interstitial gastritis was present in every case infected with HP, but the same gastritis was present in one half of mucosas, without infection by HP. This particular gastritis in probably caused by reflux. The role of HP in the relapse of ulcers therefore remains to be demonstrated.