Training trends and practice pattern of intestinal anastomosis among Nigerian Postgraduate Trainees: A cross-sectional survey

Abstract

Background: The concept of mentor-mentee skills learning in surgical education has been the bedrock of training and knowledge acquisition over many years. Techniques of intestinal anastomosis are one of the fundamentals skills to be mastered in the early career of trainees in surgery. This study aims to evaluate the training trends and current practice of intestinal anastomosis amongst Nigerian postgraduate trainees. Methods: A cross-sectional survey using a self-administered questionnaire was conducted on surgical trainees who attended the 2020 annual revision course of the National Postgraduate Medical College in Lagos. Results: Response rate was 74.1%. The age range of respondents was 29–52 years with a mean 35.5 ± 4.6 years. Majority of the respondents had their future career interest in general surgery and were in the second (43.3%) and third (38.3%) postgraduate year in surgery. Nontraumatic emergency abdominal conditions (71.7%) were the most common indication for gastrointestinal anastomosis. Majority of the respondents practice prophylactic use of bowel preparation and nasogastric tube placement for elective colorectal procedures. Two-layer anastomosis using synthetic absorbable suture was favored by most respondents. This was the technique of choice regardless of the segment of the bowel involved in the anastomosis. Fifth postoperation day was the most preferred time for the commencement of oral intake. Twenty respondents gave an estimated anastomotic leak rate of 0%–10% and this was attributed to systemic factors by 71.7% of the respondents. Two-third of respondents rated their current anastomotic skills as good even though 86.7% of respondents desired further formal training in intestinal anastomosis. Conclusion: Nontraumatic emergency abdominal conditions were the most common indication for intestinal anastomosis. The traditional two-layer anastomosis with synthetic absorbable sutures was favored over other anastomotic techniques. Majority would commence oral feeding on 5th day postoperation. Self-rated anastomotic leak reported by a third of respondents was ≤10%.