Laparoscopic Roux-en-Y Gastric Bypass: Differences in Outcome between Attendings and Assistants of Different Training Backgrounds

Hsu, Gloria P.; Morton, John M.; Jin, Li; Safadi, Bassem Y.; Satterwhite, Thomas; Curet, Myriam J.

doi:10.1381/0960892055002374

Cited by 43 publications

(31 citation statements)

References 9 publications

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“…More research is required to determine which practice patterns most effect outcomes including preoperative weight loss, advanced surgical training, and surgical assistant status (58,59). Given this need for further research, clinically derived prospectively maintained databases regarding bariatric surgery are required (56,60).…”

Section: Perioperative Risk and Care Of Bariatricmentioning

confidence: 99%

Bariatric Surgery in Patients With Morbid Obesity and Type 2 Diabetes

Schernthaner

Morton

2008

Diabetes Care

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Section: Perioperative Risk and Care Of Bariatricmentioning

confidence: 99%

Bariatric Surgery in Patients With Morbid Obesity and Type 2 Diabetes

Schernthaner

Morton

2008

Diabetes Care

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“…Laparoscopic gastric bypass (LGB) can be a technically challenging operation, and surgeons must master the technique in order to provide a safe surgery and must perform long-term follow-up on the patient. Surgeons must overcome a long learning curve before mastering LGB; some authors estimate that 75-120 procedures are needed to achieve optimum postoperative outcomes [6][7][8][9]. During the learning curve, the complication rate can be even two to three times higher than suspected [8,10].…”

Section: Introductionmentioning

confidence: 99%

Training Programs Influence in the Learning Curve of Laparoscopic Gastric Bypass for Morbid Obesity: A Systematic Review

et al. 2011

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The makeup of a new surgical bariatric team may be associated with a higher number of postoperative complications due to the learning curve. The aim of this study was to evaluate the outcomes during the learning curve of laparoscopic gastric bypass (LGBP) depending on surgeons' training. A systematic approach was used to review studies from the Pubmed, Embase (Ovid), Cancer Lit, Biomes Central via Scirus, Current Contens (ISI), and Web of Science (SCI) databases. Two reviewers independently screened all titles/abstracts and included/excluded studies based on full copies of manuscripts. The outcomes included were: specific training of the surgeon, postoperative complications (leaks, occlusion, hemorrhage, pneumonia, etc.), mortality, and surgical technique. One reviewer put data onto an Excel spreadsheet. Statistical analysis was performed with weighted linear regression. We identified 448 citations, of which 120 abstract and 50 full-text publications were reviewed. Fourteen papers were selected. Data from 1,848 patients were included. Eighteen different surgeons were analyzed during their learning curve (including the first author of this study). Surgeons were divided into two groups: (1) without formal laparoscopic bariatric training (13 surgeons) and (2) with formal laparoscopic bariatric training (five surgeons). Postoperative complications were more frequent in group 1: 18.1% (± 7.6) vs. 7.7% (± 1.96, p = 0.046); also, mortality was more frequent in group 1: 0.57% (± 0.87) vs. 0% (p = 0.05). An appropriated training in laparoscopic bariatric surgery contributes to a significant reduction in postoperative complications and mortality during the learning curve of LGBP.

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“…Reduction in morbidity and mortality associated with LRYGB has been shown to occur as a function of surgical experience [7][8][9]. This important issue has been recognized by the American Society for Metabolic and Bariatric Surgery (ASMBS) in its published Guidelines for Granting Privileges in Bariatric Surgery [10].…”

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confidence: 99%

Validation that a 1-year fellowship in minimally invasive and bariatric surgery can eliminate the learning curve for laparoscopic gastric bypass

et al. 2009

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Background The concept that advanced surgical training can reduce or eliminate the learning curve for complex procedures makes logical sense but is difficult to verify and has not been tested for laparoscopic Roux-en-Y gastric bypass (LRYGB). We sought to determine if minimally invasive/bariatric surgery fellowship graduates (FGs) would demonstrate complication-related outcomes (CRO) equivalent to the outcomes achieved during their training experience under the supervision of experienced bariatric surgeons. Methods We compared CRO for the first 100 consecutive LRYGBs performed in practice by five consecutive minimally invasive/bariatric fellows at new institutions (total 500 cases) to CRO for the 611 consecutive LRYGBs performed during their fellowship training experience under the supervision of three experienced bariatric surgeons at the host training institution. Results The two patient groups did not differ demographically. The 18 types of major and minor complications identified after LRYGB did not differ among the five fellowship graduates. The mentors' CRO were compatible with published benchmark data. As compared with the training institution data, the overall incidence of complications for the combined experience of fellowship graduates did not differ statistically from that of the mentors. The fellowship graduates' early experience included zero nongastrojejunostomy leaks (0% versus 1.5%) and a low rate of anastomotic stricture (0.8% versus 3.0%), incisional hernia (1% versus 4.4%), bowel obstruction (0% versus 3%), wound infection (0.3% versus 3.1%), and gastrointestinal hemorrhage (0.2% versus 1.6%). The rate of gastrojejunostomy leak (1.8% versus 2.6%) and, most importantly, mortality (0.8% versus 0.7%) did not differ between the two groups. Conclusions Fellowship graduates achieved high-quality surgical outcomes from the very beginning of their postfellowship practices, which are comparable to those of their experienced mentors. These data validate the concept that advanced surgical training can eliminate the learning curve often associated with complex minimally invasive procedures, specifically LRYGB.

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Laparoscopic Roux-en-Y Gastric Bypass: Differences in Outcome between Attendings and Assistants of Different Training Backgrounds

Cited by 43 publications

References 9 publications

Bariatric Surgery in Patients With Morbid Obesity and Type 2 Diabetes

Bariatric Surgery in Patients With Morbid Obesity and Type 2 Diabetes

Training Programs Influence in the Learning Curve of Laparoscopic Gastric Bypass for Morbid Obesity: A Systematic Review

Validation that a 1-year fellowship in minimally invasive and bariatric surgery can eliminate the learning curve for laparoscopic gastric bypass

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