Leveling the learning curve for laparoscopic bariatric surgery.
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.
Lublin
M
M
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
Lyass
S
S
Lahmann
B
B
Cunneen
S A
SA
Khalili
T M
TM
Elashoff
J D
JD
Phillips
E H
EH
D000293:Adolescent; D000328:Adult; D000368:Aged; D002983:Clinical Competence; D005260:Female; D015390:Gastric Bypass / Q000193:education* / Q000379:methods* / Q000592:standards; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged