To the Editor.—One of the main conclusions in the article by Pearl and colleagues was that "The morbidity of stoma formation seems to be related to the amount of formal training in gastrointestinal tract surgery." I believe that this statement was unsupported because the authors did not specify which member of the operating team performed the stoma or the amount of "formal training" that surgeon previously had received. The authors compared groups of surgical specialties but failed to support their conclusions by documenting either the years of formal training for each group or the number of actual gastrointestinal procedures performed by each specialist during the training years.
One of the authors' reasons for the above conclusions was the higher complication rate, 36.9%, observed in the gynecologic oncology surgical specialty. The authors assumed but did not show that this surgical group had less formal training in gastrointestinal tract surgery. Furthermore,