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Leveling the learning curve for laparoscopic bariatric surgery
1Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
Background:
The learning curve for laparoscopic bariatric surgery is associated with increased morbidity and mortality.
Methods:
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).
Results:
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).
Conclusions:
By transferring skills in stages, a laparoscopic bariatric program can be established with minimal morbidity and mortality.
