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A new and simplified technique for laparoscopic gastric bypass in a residency training program: decreased resource
Matthew J Martin1, Matthew J Eckert, William E Eggebroten
1Department of Surgery, Madigan Army Medical Center, 9040-A Fitzsimmons Ave., Tacoma, WA 98431-1100, USA. matthew.martin1@amedd.army.mil
Background:
Laparoscopic gastric bypass (LGB) is an advanced complex procedure. Teaching programs must balance resident training and participation with resource utilization, patient safety, and outcomes. We prospectively studied a new simplified LGB technique (S-LGB) in a residency training program.
Design:
Prospective observational study.
Setting:
Academic bariatric program.
Patients:
All patients undergoing S-LGB during 17 months.
Interventions:
Clinical data collection and surgeon survey.
Main Outcome Measures:
Resource utilization, patient outcomes, and resident/staff satisfaction.
Results:
There were 140 S-LGB operations performed by 4 staff members, all with postgraduate year 2 through 5 residents. There were no major intraoperative complications and no anastomotic leaks or deaths. Mean operative time for cases with no concurrent procedures was 91 minutes, with no intraoperative transfusions and 1 conversion to an open procedure. Compared with our standard technique, operative times with simple S-LGB decreased by an average of 56% for all staff (range, 45%-60%; P < .01). Lower postgraduate year level increased operative times with the standard technique but not with S-LGB. The anastomotic stricture rate decreased from 10.0% to 3.6% (P = .02). The mean excess body weight lost at 3, 6, and 12 months was 42%, 55%, and 87%, respectively. All staff surgeons preferred the S-LGB technique for technical difficulty, speed, safety, and ability to teach residents. Residents scored the S-LGB significantly better than our standard technique for difficulty, learning curve, and overall satisfaction (all P < .05).
Conclusion:
Introduction of S-LGB has resulted in excellent outcomes and significant reductions in resource utilization while enhancing opportunities for resident teaching and full participation.
