With better weight loss than LAGB and lower complication rates than RYGB, SG is a reasonable choice for the treatment of morbid obesity and should be covered by both public and private payers.

To evaluate the effectiveness and safety of 3 predominant venous thromboembolism (VTE) prophylaxis strategies among patients undergoing bariatric surgery.

STRUCTURED ABSTRACT Background Recent data establishes a strong link between peer video ratings of surgical skill and clinical outcomes with laparoscopic gastric bypass. Whether skill for one bariatric procedure can predict outcomes for another, related procedure is unknown. Methods Twenty surgeons voluntarily submitted videos of a standard laparoscopic gastric bypass procedure, which was blindly rated by 10 or more peers using a modified version of the Objective Structured Assessment of Technical Skills (OSATS). Surgeons were divided into quartiles for skill in performing gastric bypass and their outcomes within 30 days after sleeve gastrectomy were compared. Multivariate logistic regression analysis was utilized to adjust for patient risk factors. Results Surgeons with skill ratings in the top (n=5), middle (n=10, middle two combined), and bottom (n=5) quartiles for laparoscopic gastric bypass had similar rates of surgical and medical complications following laparoscopic sleeve gastrectomy (top 5.7%, middle 6.4%, bottom 5.5%, p=0.13). Furthermore, surgeon skill ratings did not correlate with rates of reoperation, readmission and emergency department visits. Top rated surgeons had significantly faster operating room times for sleeve gastrectomy (top 76 min, middle 90 min, bottom 88 min; p<0.001) and a higher annual volume of bariatric cases per year (top 240, middle 147, bottom 105; p=0.001). Conclusions Video ratings of surgical skill with laparoscopic gastric bypass do not predict outcomes with laparoscopic sleeve gastrectomy. Evaluation of surgical skill with one procedure may not apply to other related procedures and may require independent assessment of surgical technical proficiency.

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