Eliminating learning curve-related morbidity in fast track laparoscopic Roux-en-Y gastric bypass

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is associated with a significant learning curve. We report the results of a systematic training program from a high-volume bariatric center measuring the outcome by comparing the results with data from a consecutive series of 1000 fast-track LRYGB.

Using a stepwise training program, the Roux-en-Y gastric bypass operation was divided into an upper and lower procedure and subdivided into 11 well-defined steps. A laparoscopic surgeon without experience in upper-gastrointestinal surgery was mentored by an experienced bariatric surgeon. During 6-month full-time fellowship, 300 operations were performed.

The trainee surgeon performed 61 upper procedures and 121 lower procedures in which the mentor surgeon did the other part of the operation. In 110 patients, the trainee performed both procedures. Two percent had perioperative complications compared with 1% of 1000 patients. All were repaired and had an uneventful recovery. Two percent had postoperative complications <30 days compared with 2.8% in the clinic. In the trainees series, there were no leaks compared with 1% in 1000 patients. Operative time was 56/55/70 minutes for operation 0-100/100-200/200-300 compared with an average of 47 minutes registered in the clinic. Concerning time to discharge, there was no difference between patients operated by the trainee and the standard of the clinic.

Using a systematic training program in LRYGB surgery eliminates morbidity of the learning curve without affecting the volume.