Practice of proctology among general surgery residents and young specialists in Italy: a snapshot survey

Abstract

Anal diseases are very common and, in most of the cases, require surgery of minor or medium complexity, and, therefore, are among the most accessible diseases for surgeons in training. Aim of this study is to investigate the status of the training in proctology in Italy. A 31-items questionnaire was administered to residents and young specialists (≤ 2 years) in general surgery, using mailing lists, and the social media accounts of the Italian Society of Colorectal Surgery. Answers from 338 respondents (53.8% males) were included in the final analysis. Overall, 252 respondents (74.5%) were residents and 86 (25.5%) young specialists. Two hundred and fifty-five (75.4%) respondents practiced proctology for the first time early on during their postgraduate training, but only 19.5% did it continuously for ≥ 24 months. Almost all respondents (334; 98.8%) had the chance to participate in proctological procedures, 205 (60.5%) as first surgeon. This percentage decreases according to the complexity of the surgery. In fact, only 11 (3.3%) and 24 (7.1%) of the respondents were allowed to be the first surgeon in more complex proctological diseases such as surgery for rectal prolapse and fecal incontinence. The present survey suggests that, in Italy, most surgeons in training deal with anal diseases. However, only few of them could achieve sufficient professional skills in the management of proctological diseases to be able to practice autonomously as young specialists.

Appendix 1

Snapshot survey

General information and interest for proctology	Q1	In which region do you work, or did you train?
	Q2	Are you a resident or surgeon for less than 2 years? If resident, which year do you attend?
	Q3	Before starting training program, did you already have a specific interest in proctology as a sub-discipline of colorectal surgery?
	Q4	From which year of training school did you come into contact with proctology?
	Q5	For how many months in total have you participated/performed proctological activities?
	Q6	In the training location where you are or have you previously been, what type of activity is/was present?
	Q7	Have you ever attended proctological surgery?
	Q8	Have you ever performed (as first operator) proctological surgery?
Surgical activity Indicate the number of procedures you have performed as assistant/first surgeon	Q9	Rubber band ligation (RBL)
	Q10	Sclerotherapy
	Q11	Transanal hemorrhoidal dearterialization (THD) or similar
	Q12	Stapled hemorrhoidopexy (Procedure for prolapse and hemorrhoids, PPH)
	Q13	Hemorrhoidectomy (Milligan-Morgan, Ferguson, etc.)
	Q14	Abscess drainage
	Q15	Seton placement
	Q16	Curative procedures for perianal fistula (fistulotomy, fistulectomy, LIFT, RAF, etc.)
	Q17	Lateral internal sphincterotomy (LIS) for anal fissures
	Q18	Botulinum toxin injection
	Q19	Advancement flap
	Q20	Removal of perianal lesions (condyloma, anal tags, etc.)
	Q21	Procedures for pilonidal disease
	Q22	Have you ever assisted or performed as first operator a rectal prolapse correction?
	Q23	Have you ever assisted or performed as first operator surgery for fecal incontinence (sacral neuromodulation, filling, neosphincters, etc.)?
Diagnostic activity	Q24	Have you ever performed an anoscopy?
	Q25	Have you ever performed an anorectal manometry?
	Q26	Have you ever performed an endoanal ultrasound?
Research activities	Q27	Have you participated in national/international collaborative studies on proctological surgery topics? If so, how many collaborative studies?
	Q28	Have you ever published an original article on proctological surgery topics? If so, how many original articles?
	Q29	Are you a member of scientific societies in the proctological field?
	Q30	Have you ever taken part in masterclasses, congresses, webinars in the proctology field?
	Q31	Have you ever presented scientific works in the proctology field at congresses or conferences?

1. LIFT ligation of intersphincteric fistula tract; RAF rectal advancement flap