title: The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases.
abstract: BACKGROUND
  The purpose of this study was to determine the effect of operative experience on perioperative outcomes for laparoscopic Roux-en-Y gastric bypass (LGB).
  
  
  METHODS
  Between July 1997 and September 2001, 750 patients underwent LGB for the treatment of morbid obesity at our center. We evaluated the perioperative outcomes of the first 150 consecutive patients to determine if a learning curve effect could be demonstrated. The patients were divided into three groups (1, 2, and 3) of 50 consecutive patients, and outcomes for each group were compared.
  
  
  RESULTS
  The patients in group 3 had a larger body mass index (BMI), were more likely to have had prior abdominal surgery, and were more likely to have secondary operations at the time of LGB. Operating time decreased from a mean of 311 min in group 11 to 237 min in group 3, and technical complications were reduced by 50% after an experience of 100 cases.
  
  
  CONCLUSIONS
  Operative time and technically related complications decreased with operative experience even though heavier patients and higher-risk patients were more predominant in the latter part of our experience. LGB is a technically challenging operation with a long learning curve. To minimize morbidity related to the learning curve, strategies for developing training programs must address these challenges.
authors.affiliation: Department of Surgery, The Minimally Invasive Surgery Center, University of Pittsburgh, Presbyterian University Hospital, C-800, 200 Lothrop Street, Pittsburgh, PA 15213-2582, USA. schauerpr@msx.upmc.edu
authors.forename: P
authors.initials: P
authors.lastname: Schauer
authors.forename: S
authors.initials: S
authors.lastname: Ikramuddin
authors.forename: G
authors.initials: G
authors.lastname: Hamad
authors.forename: W
authors.initials: W
authors.lastname: Gourash
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000193:education / Q000706:statistics & numerical data*; D005260:Female; D015390:Gastric Bypass / Q000193:education / Q000706:statistics & numerical data*; D006801:Humans; D007318:Inservice Training / Q000706:statistics & numerical data; D010535:Laparoscopy / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States