Authors's Response 1.

We agree with Laughlan and colleagues that the proportion of laparoscopic appendicectomies performed in our district general hospital is considerably less than those performed in a teaching hospital, and that this could explain why our study did not demonstrate the reduction in SHO operative experience we expected to find. Nevertheless, we believe that our data are likely to reflect the situation in many district general hospitals, with the change in working patterns having a far greater influence on SHO training experiences over the last 10 years. Despite this, the data provided by Laughlan and co-workers suggest that the further popularisation of laparoscopic appendicectomy is likely to contribute to the depletion of SHO training opportunities. This serves to highlight the pressing need to re-examine the way in which junior surgeons are trained.