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Title

Leveling the learning curve for laparoscopic bariatric surgery.

Authors

Lublin, M.; Lyass, S.; Lahmann, B.; Cunneen, S. A.; Khalili, T. M.; Elashoff, J. D.; Phillips, E. H.

Abstract

<bold>Background: </bold>The learning curve for laparoscopic bariatric surgery is associated with increased morbidity and mortality.<bold>Methods: </bold>The study included the first 100 patients undergoing laparoscopic Roux-en-Y gastric bypass (LGB) by a designated surgical team. Surgeon A operated as primary surgeon, with surgeon B assisting (Stage 1). Surgeon B learned LGB in stages: exposure and jejunojejunostomy (stage 2), gastric pouch (stage 3), gastrojejunostomy (stage 4), and sequence all steps (stage 5).<bold>Results: </bold>Surgeon A achieved confidence with LGB after 20 cases and surgeon B after 25 cases (stage 2), 18 cases (stage 3), 21 cases (stage 4), and 16 cases (stage 5). Complications (8%) included small bowel obstruction (three); pulmonary embolus (two), and leak, stomal stenosis, and gastrogastric fistula (one each). There was a decreasing trend for operative duration, length of stay, and complications across the five stages (p < 0.05).<bold>Conclusions: </bold>By transferring skills in stages, a laparoscopic bariatric program can be established with minimal morbidity and mortality.

Subjects

MORTALITY; DISEASES; BARIATRIC surgery; LAPAROSCOPIC surgery; GASTRIC bypass; JEJUNOSTOMY; JEJUNUM surgery

Publication

Surgical Endoscopy & Other Interventional Techniques, 2005, Vol 19, Issue 6, p845

ISSN

1866-6817

Publication type

Academic Journal

DOI

10.1007/s00464-004-8201-x

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