Advanced Gastrointestinal Surgery Fellowship Programs: Filling a Gap in Surgical Training?

Objective: The goal of the 1-year Advanced Gastrointestinal (AGI) surgery fellowship is to train the general surgeon to perform advanced and complex operations that they had insufficient experience with in residency training. This study examines the case logs of AGI fellows that have completed Society for Surgery of the Alimentary Tract (SSAT)-sponsored Fellowship Council (FC)-accredited AGI fellowships to determine the role of these fellowships in providing complex gastrointestinal operative experience.

Design/participants: Institutional Review Board-approved retrospective surgical case log analysis. Case logs of 60 AGI fellows in 12 different AGI fellowships from 2014 to 2019 were requested by the SSAT and provided in a de-identified format from the FC. Cases were categorized as colorectal surgery, anus, hernia-abdomen, hernia inguinal, esophagus-hiatal hernia, esophagus-Heller, pancreas, liver, bile duct, diagnostic/therapeutic esophagogastroduodenoscopy (EGD), diagnostic/therapeutic colonoscopy, thoracic esophagus, thoracic lung, spleen, thyroid, diaphragm, gastric, abdomen, adrenal/kidney, bariatric, diagnostic/therapeutic bronchoscopy, kidney/liver/pancreas transplant, and trauma.

Results: AGI fellows performed a mean of 345 cases per year (range: 184-558). Our results showed that 5 programs provided >30 colorectal cases, 6 provided >50 hernia (hernia-abdomen and hernia-inguinal) cases, 8 provided >25 hiatal hernia cases, 2 provided >100 endoscopy cases (diagnostic/therapeutic EGD and diagnostic/therapeutic colonoscopy), 6 provided >30 gastric cases, 3 provided >100 bariatric cases, 6 provided >10 pancreas cases, 3 provided >10 liver cases, and 4 provided >6 biliary cases.

Conclusion: SSAT-sponsored FC-accredited AGI fellowship programs provide a wide array of training in complex gastrointestinal surgeries. Most programs provide broad training in hiatal work, colorectal surgery, hepato-pancreato-biliary surgery, and abdominal wall reconstruction. This FC-accredited AGI training paradigm prepares trainees for broad-based complex abdominal surgery, an area that is sorely needed to augment insufficient experience in many general surgical training programs.