Biliary Surgery During Residency: A Nationwide Study

Introduction: Biliary surgeries present a challenge in general surgery training. Increased exposure to laparoscopic techniques, coupled with a decline in experience with open procedures and more complex biliary interventions, has become a point of concern for general surgery residency programs. The objectives of this article are to assess the biliary surgery experience of general surgery residents across Portugal, compare it with the training in other Western countries, and evaluate differences between the curricula of residents trained in central hospitals and those in district hospitals. Methods: An analysis was conducted using data from an online questionnaire administered to general surgery residents in Portugal in 2023. Results: Out of 93 residents with more than one year of experience, 63 were in their final three years of residency (68%). The majority were from district hospitals (61, 66%). While 88 residents had assisted in an open cholecystectomy, only 63 (72%) had performed one, with most being in their final years of training. Only 28 residents (32%) felt confident in performing this procedure. 88 residents had performed a laparoscopic cholecystectomy, 59 (67%) completed more than 20, including two residents in their second year (R2Y). Fifty­ ‑seven residents had converted a laparoscopic cholecystectomy, and 8 were unable to complete the surgery. In cases requiring conversion, most residents employed a “fundus­ ‑first” technique. When faced with a challenging laparoscopic case, 10 residents (11%) would choose to convert, while 60 (64%) preferred performing a laparoscopic subtotal cholecystectomy, and 23 (25%) favored the laparoscopic “fundus­ ‑first” approach. Thirty­ ‑four residents had performed intraoperative cholangiograms, with 32 (94%) doing so electively. Seventeen residents had performed biliary tree exploration, and 9 had performed a biliodigestive anastomosis. All respondents agreed on the need for further training in biliary surgery. Conclusion: There is widespread concern about the lack of experience with cholangiography and bile duct exploration, highlighting the need for practical training tools to improve residents’ proficiency in these critical areas.